Vienna Band Camp 2019 Registration
Dates of camp are June 17-July 12 at Longfellow Middle School.

Reminder - Beginning Band students MUST bring a "Standard of Excellence" Book 1 for their instrument with them on the first day. You can purchase this easily online, or by going to Foxes or Music and Arts.

If you have questions regarding the camp activities, classes, curriculum, etc. please contact Brad Zimmerman at 703-533-2647.

If you have questions regarding this form or registration, please contact Christina Weise at cbweise@fcps.edu.

Which program will you be participating in? *
Student First Name *
Your answer
Student Last Name *
Your answer
Student Age *
Your answer
Student T-Shirt Size *
These are ADULT sizes.
Street Address *
Number or Apt and Street Name
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Current School *
Your answer
Current Grade *
Reminder - VBC is for students 4th grade through 9th grade
Instrument *
Reminder - Beginners should have chosen an instrument prior to coming to VBC and arrive with that instrument on the first day. Also, Beginning Saxophone is not offered at VBC.
Number of years you have played this instrument *
If you are a beginner please type "0"
Your answer
Student Home Phone Number *
Your answer
Parent #1 Name - first and last *
Your answer
Parent #1 Work Phone Number *
If none then please type "none"
Your answer
Parent #1 Cell Phone Number *
If none then please type "none"
Your answer
Parent #1 Email Address *
If none then please type "none"
Your answer
Parent #2 Name - first and last *
If none then please type "none"
Your answer
Parent #2 Work Phone Number *
If none then please type "none"
Your answer
Parent #2 Email Address *
If none then please type "none"
Your answer
Parent #2 Cell Phone Number *
If none then please type "none"
Your answer
Would you be willing to be included on our carpool list? If so, please select the ELEMENTARY SCHOOL that you live closest to.
Note - We do NOT arrange carpools for you. We simply provide you with a list of others that live near you and would like to carpool. This will be sent via email the week prior to the start of camp as well as hard copies provided in the lobby on the first day.
Emergency Care Information
Physician's Name *
Your answer
Physician's Phone Number *
Your answer
Please list any allergies, medical conditions, or medication that are important for us to know about in case of an emergency.
Your answer
In case of emergency, please list at least TWO people that we can contact if we cannot reach you. Please also list their best contact information in this text box for each one. *
Your answer
Emergency Care and Student Conduct Agreements
Parent Agreement - The camp has my permission to seek emergency care for my child at the nearest hospital when I or my physician cannot be contacted. The hospital and its medical staff have my authorization to provide any treatment which a physician deems necessary for the well-being of my child. I understand that the camp will provide adequate supervision during the operating hours of the camp and will provide full accident insurance for my child while in camp. I will not hold the camp or the Fairfax County School Board liable for bodily injury that might occur through accident while my child is at the camp beyond the limits of the camp insurance carried for such injury.

Student Agreement - In order to ensure that the Vienna Summer Band Camp is an enjoyable and educational musical experience for all students, it is necessary that each student to accept the responsibility for his/her behavior and to participate in an acceptable manner. Students must attend all classes while in the building and are not to leave the school grounds. Areas of the school which are not in use by the camp are off limits to all students. Failure to adhere to these rules and to follow regulations as established by the Vienna Band Camp staff will result in dismissal from the camp.

Acknowledgement of the agreements listed above. *
Payment required now
Once you push submit for this form, you will be taken to a confirmation page with instructions for how to submit payment via PayPal. You must complete payment for registration to be complete. Form submissions without payment will be automatically deleted.
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