Summer Music Institute
Camp Registration and Payment
Name
First Name
Last Name
Cell Number
-
Area Code
Phone Number
Email
example@example.com
Age
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Grade in Fall
Gender
Please Select
Female
Male
Director's Name
School
Primary Instrument or Voice
Please Select
Voice - Soprano
Voice - Alto
Voice - Tenor
Voice - Bass
Flute
Oboe
Clarinet
Bass Clarinet
Contra Bass Clarinet
Bassoon
Contra Bassoon
Alto Sax
Tenor Sax
Bari Sax
Trumpet
Horn
Trombone
Bass Trombone
Euphonium
Tuba
Percussion
Bass Guitar
Guitar
Drumset
Piano
Vibraphone
Violin
Viola
Cello
Double Bass
Secondary Instrument or Voice
Please Select
Voice - Soprano
Voice - Alto
Voice - Tenor
Voice - Bass
Flute
Oboe
Clarinet
Bass Clarinet
Contra Bass Clarinet
Bassoon
Contra Bassoon
Alto Sax
Tenor Sax
Bari Sax
Trumpet
Horn
Trombone
Bass Trombone
Euphonium
Tuba
Percussion
Bass Guitar
Guitar
Drumset
Piano
Vibraphone
Violin
Viola
Cello
Double Bass
Application Completed by
Please Select
Parent
Guardian
Student Applicant
Parent Name
First Name
Last Name
Parent Email
example@example.com
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T-Shirt Size
Please Select
S
M
L
XL
XXL
XXXL
Adult Size - Resident Camper ONLY
Resident/ Commuter?
Please Select
Resident Camper (All meals and Lodging Provided)
Supervised Commuter (Lunch/Dinner Provided)
Unsupervised Commuter (No Meals Provided)
Previous Camper
Please Select
Yes
No
Private Lesson
Please Select
Yes
No
Paid directly to the Instructor: $15
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If you are recieving a local scholarship (band boosters, women's club, etc.) list it below.
Local Scholarship Awarded by
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Payment Review
Today's Payment Amount
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( X )
Week 1 Day Camps - June 11-15, 2018 - Rock's Youth
$
50.00
Week 1 Day Camps - June 11-15, 2018 - Steel Band
$
50.00
Week 2 Camps - June 17-22, 2018 - Choir, Jazz, String, Live Streaming
$
550.00
Week 3 Camps - June 24-29, 2018 - Band, Marching Leadership
$
550.00
Total
$
0.00
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