Dive Into Band Camp Sign-Up

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Please use this form to sign-up for the SEMYO band camp or beginning students. This form should be completed by a parent or guardian. Please register on or before Friday, June 3. For more information and to pay tuition online please visit https://www.semyo.org/string-camp/. Contact Corey Henke at chenke@semyo.org with questions.

Student First Name *

Student Last Name *

Instrument *

Current Grade *

Name of School

Name of Music Teacher (s) *

Parent or Guardian Full Name *

Additional Parent or Guardian Name

E-mail Address (Primary Contact) *

Secondary E-mail Address (Optional)

Phone Number *

Would you like to receive camp updates via text to this phone number?

Yes

Clear selection

Mailing Address

Please provide the name and phone number of an emergency contact that can be reached during the camp if needed. *

Please list any allergies

Please list any health conditions or concerns that the SEMYO staff should be aware of.

All participants will receive a camp t-shirt. Please indicate size below. *

Youth XS

Youth S

Youth M

Youth L

Youth XL

Adult Small

Adult Medium

Adult Large

Adult X-Large

Adult XX-Large

As participants in a performing arts organization, participants in SEMYO may appear on online video, or SEMYO publicity materials (brochures, posters, social media, etc.). *

I give permission for my child to appear in SEMYO publicity materials.

I do NOT give permission for my child to appear in SEMYO publicity materials.

I give my child permission to participate in Dive into Band Camp hosted by Southeastern Minnesota Youth Orchestras (SEMYO) the week of June 20-24, 2022, at Gloria Dei Lutheran Church. I hereby voluntarily agree to assume all risks and responsibilities surrounding my child’s participation in the Dive into Band Camp (June 20-24). I hereby release, indemnify, and agree to hold harmless the Board of Directors of the Southeastern Minnesota Youth Orchestras, its officers, agents, director’s, volunteers, representatives, and the Summer Camp site host (Gloria Dei Lutheran Church) from any liability or claims which may result from my child’s participation. Furthermore, if my child should need medical attention during the time of the Dive into Band camp rehearsals or performance, SEMYO will make every effort to contact me, the parent or guardian, for directions as to that care. If I cannot be reached, I hereby authorize SEMYO staff to obtain emergency medical care for my child during summer camp activities. I understand that I am responsible for the costs of all services and medications. (The use of electronic signatures is permitted. By signing electronically, you are agreeing to the terms listed above and your typed signature binds the waiver.) Signature of parent/guardian and date:

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