Camper Application

What is the name of the camper attending?
First:

Last:

What are the names of the parent or guardian responsible for the camper?

Please provide the best address for contacting?

Address:

Phone #:

Work #:

Cell #:

Parent Email Address:

Medical Plan/Insurance:

Emergency Contact:

Work #:

Cell #:

Please list any Medical Conditions, Allergies, Emotional/Behavioral issues that the staff should know about?

Please list any daily medications:

Do we need to dispense:
YesNo

If yes, please fill out a schedule of medicine dosage & time(s) of day:

Do you need to apply for a full or partial scholarship?
YesNo

If so, then for how much?

What can you afford to pay?

Annual Income:

Can you help by bringing water & snacks?
YesNo

CAMPER INFO

Camper Nickname:

Camper Age:

What is the week of camp you would like to apply for?

Have you stayed somewhere overnight before?
YesNo

How did you hear about us?

Please select T-shirt size:

Instrument of choice (includes voice):

Have you taken any lessons?
YesNo

Will you bring any instrument(s) to camp?
YesNo

Do you sing?
YesNo

Do you write (songs, poetry, keep a journal)?
YesNo

Favorite type(s) of music:

Favorite song?

Favorite 3 artists:

Please tell us why you want to attend this camp:

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