Summer Music Camp Registration Child's Name* First Last Grade Child Will Be Entering*3rd4th5th6th7th8th9thChild's Shirt Size*Extra SmallSmallMediumLargeExtra LargeAdult SmallAdult MediumAdult LargeAdult Extra LargeParent Name:* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone NumberCell Number*Email* Emergancy Contact Name:* First Last Emergancy Contact Number:*All Known Allergies (food, bee stings, medications, etc), Medical Info, Food Needs, Concerns:How did you hear about this camp?*Home Visitor NewsletterWebsiteFacebookFamily Member/FriendSunday Morning ServiceOther* As parent/guardian of the aboved-named minor child, I give Ormond Beach Presbyterian Church permission to video or photograph my child for marketing, decorative or promotional use. * I acknowledge and consent that this electronic signature shall have the full force and affect of a hard copy and shall be given the same viability under the law as such. Signature* First Last Date* Date Format: MM slash DD slash YYYY