Central Fairfax Band Camp 2019
Student First Name: *
Your answer
Student Last Name: *
Your answer
Student T-shirt Size *
(In adult sizes)
Current School *
(2018-2019 School Year)
Your answer
Grade Next Year *
(Rising)
What school will your child attend next year? *
Your answer
Instrument *
Beginners must choose an instrument before the 1st day of camp. All students should arrive with an instrument on the 1st day of camp. Consult your school's band teacher for instrument rental recommendations.
Years Played on Instrument *
Beginning Band students should select "0"
Home Address *
Number, Apt., and Street Name
Your answer
City and State *
Your answer
Zip Code *
Your answer
Home Phone *
Your answer
Work Phone *
Your answer
Parent Cell *
Your answer
Parent Email *
Your answer
Would you like to be included in the Carpool List?
If so please write in your subdivision. A spreadsheet will be emailed out a week before camp begins to those interested in carpooling. If you are not interested, please leave this line BLANK.
Your answer
EMERGENCY CARE INFORMATION
Physician's Name *
Your answer
Physician's Phone Number *
Your answer
Please list any medical conditions we should know about in case of an emergency.
Your answer
Please list an emergency contact name and phone number in the event that we cannot reach you. *
Your answer
Emergency Care and Student Conduct Agreement
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 Central Fairfax 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 Camp staff may result in dismissal from the camp.

Parent and Student Acknowledgement *
PAYMENT
Once you press Submit please return to the homepage and pay for camp by clicking on the 'Pay Now' tab.
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