HummingBird Music Camp
2008 Registration
Campers First Name:
Middle Name:
Last Name:
Gender:
male
female Birthday Date:
Grade Fall '08:
Address:
City:
State:
Zip:
Phone:
Business:
Med. Ins. Co.:
Policy #:
Family Dr.:
Phone:
Last Tetanus:
Hospital:
Any physical condition requiring attention (allergies), special Needs or Comments
I authorize emergency medical treatment and/or hospitalization if
necessary for this camper. (by typing name you are authorizing)
Parent/Guardian Signature:
MUSIC WEEKS
(Sunday to Sunday) -
I wish to enroll for the following:
1 week or
2 weeks
WEEK 1.......MAY 25 - JUNE 1
WEEK 2.......JUNE 1 - 8
WEEK 3.......JUNE 8 - 15
WEEK 4.......JUNE 15 - 22
WEEK 5.......JUNE 22 - JUNE 29
WEEK 6.......JUNE 29 - JULY 6
WEEK 7.......JULY 6 - 13
WEEK 8.......JULY 13 - 20
ART WEEK
SUNDAY, JULY 20 -
SATURDAY, JULY 26
CHESS WEEK
SUNDAY, JULY 20 -
SATURDAY, JULY 26
1st Choice: Week #
Arrival / Departure Dates
2nd Choice: Week #
Arrival / Departure Dates
Instrument I will play:
Beginner
Intermediate
Advanced
I will rent this instrument from camp for $25 per week.
I am interested in Transfer class (
Piano
Guitar
Band
Orchestra)
DEPARTURE TRANSPORTATION:
Parent
Guardian
Other
If person not designated above takes children home or away from Camp, they must sign out at the Office.
Person assuming responsibility:
Send my friend a brochure:
Address
DEPOSIT FEE: ONE WEEK $100, TWO WEEKS $200 WILL SECURE REGISTRATION
(after submitting this form)