2019 Reggie Schive Jazz Camp Registration
June 16-20, 2019 • Iowa Lakes Community College Estherville Campus
Camper First Name *
Camper Last Name *
Camper E-mail *
Parent/Guardian Email *
Returning Camper *
Gender *
I am a Resident Camper (staying on campus) or Commuter Camper (driving to and from camp daily): *
Roommate request (resident campers)
Camper Phone Number *
What is your main instrument in jazz band? *
What instrument(s) can/will you bring to camp? *
What other instruments do you play? (Not necessarily specific to jazz band.) *
What instrument would you like a second lesson on? *
Dietary, physical, or medical restrictions/alerts? *
Please explain any dietary, physical, or medical restrictions/alerts.
Outstanding Soloist Award - Include Event
Shirt Size (adult sizes) *
Grade (2018/2019 school year) *
School Name *
School Address
School City, State & Zip
Band Director Name *
Band Director E-mail *
Parent/Guardian First & Last Name(s) *
Parent/Guardian Address *
Parent/Guardian City *
Parent/Guardian State *
Parent/Guardian Zip *
Parent/Guardian Phone *
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