Summer Music Camp Registration Student's Name* First Last Grade Student Will Be Entering in the Fall 2022*4th5th6th7th8thDoes the student play any musical instruments?*YesNoIf yes, please list which instruments and how long they have played. Student's Shirt Size*Extra SmallSmallMediumLargeExtra LargeAdult SmallAdult MediumAdult LargeAdult Extra LargeParent Name:* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone NumberCell Number*Email* Emergency Contact Name:* First Last Emergency Contact Number:*All Known Allergies (food, bee stings, medications, etc), Medical Info, Food Needs, Concerns: How did you hear about this camp?*Home Visitor NewsletterOther* As parent/guardian of the above-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* MM slash DD slash YYYY