Camping Registration Form

Camping Activity Registration
Please complete the below form accurately below to book a place in the camp
Please Choose Your Camp*
Camp VenusCamp MercuryCamp MarsCamp EarthCamp UranusCamp Saturn
Camp Selection:

Available Music Instruments
Which Music Instrument do you like?*
FluteBb ClarinetBb Bass ClarinetTenor SaxBari SaxBb TrumpetBaritoneTromboneSnareTenor Drums
Indicate Your Skill Level (0-100)*

Trainees Information:
Trainees Name*
First NameLast Name
Parent/Guardian's Name*
First NameLast Name
Home Address*
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Home Phone*
Trainee's Mobile*
Parent's Mobile*
Trainees Email*
example@example.com
Parent's Email*
example@example.com
Trainee's Gender*
MaleFemale
Date of Birth*
MonthDayYear
Place of Birth

Director's Information:
Institution Name*
Director's Name*
First NameLast Name
Institution Address*
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Director's Number
Director's Email
example@example.com

Additional Information:
Please list individual honor's, e.g., member of All-State Band, Drum Corps, etc.

Parental Consent/Responsibility Clause
I Give full consent for this activity and any other effects whether positive or negative that may arise.
I understand the above agreement and by clicking next, I the applicant and parent/guardian agree to the above clause.

Payment:
Credit Card Type*
Master CardVisaAmerican ExpressDiscover
Name on Card*
Card Number*
Expiration Date (MM/YYYY)*
Security Code*
Terms/Agreements:
Should be Empty: