CUMEP Participant Registration Summer 2018
Send any questions to: cumepithaca@gmail.com
Camper Name *
Your answer
Age *
Your answer
Date of Birth *
Your answer
Address
Your answer
Email address
Your answer
Phone (home and/or cell)
Your answer
Sex:
School & Grade in Fall 2018
Your answer
Parent/Caregiver(s) name *
Your answer
Relation to camper *
Your answer
Musical Background / Interest
Your answer
Three words that describe your child’s characteristics/personality traits
Your answer
Emergency Contacts 1 *
Name, Address, Phone, Relation to camper
Your answer
Emergency Contacts 2
Name, Address, Phone, Relation to camper
Your answer
Medical Information
Medications, Allergies, Asthma, any other medical conditions or limits
Your answer
Doctor's name & Phone
*Camp staff members are not authorized to administer medication-there are some exceptions, please see staff if you have any questions or concerns
Your answer
Medical Release *
I, ___________________________________ (caregiver name), understand that the music program staff are not trained medical professionals and give permission for my child, ___________________________________ (child's name) to be transported and treated by emergency medical personnel if I cannot be reached in the even of illness or injury
Dietary Restrictions? *
If yes, please explain below
Explanation of Dietary Restrictions
Your answer
Transportation Release *
In the event of field trips during the summer program, I give permission for my child to be transported in program vehicles by trained staff. (Please enter name and date below to agree)
Your answer
Plans for pickup/after camp: *
For a, b, or d, please include names of people, names of other camps, or other arrangements below
Required
Plans for for pickup/after camp details:
Your answer
Payment plan: *
Please check the following that apply
Camper T-shirt size
Photo / Video Approval *
Please provide video/photo approval for your child for the purpose of CUMEP advertisement
Camp Attendance
Each summer we spend the first few weeks planning for an annual concert (planned for Thursday August 2nd, 2018) that includes music, dance, drama, poetry, food, and lots of fun! It is very important that campers have good attendance so that we can plan, create and prepare for this special event. We will have an opportunity to meet and interview local musicians. Parent with talents and no talents are welcome to contribute and volunteer their time during camp and the annual performance. We will also perform at local nursing homes and community centers in the neighborhood. Space for camp is limited, but we will develop a waiting list. It is preferred that participants attend camp for all 4 weeks, but please indicate if you are not able to attend one of the weeks, so we may make that space available for another camper. Please check the weeks your child(ren) plan to attend
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