Rock Enrollment Form-Summer Camps
Student Information *General Information is Requested for Contact Purposes only-We do not give or sell any information to anyone. Student Age is requested to properly group them in bands/classes according to age/interest/experience level.
Email address *
Student Name *
Your answer
Which Camp Session Are you Registering For? *
*June Camp to be only 1 week - Accelerated with Performance on Saturday Cost 195.00. July and August will be traditional 2 Week Camps.
Student's Address *
Your answer
Phone Number *
Your answer
Student Email Address:
Your answer
Age of Student *
Your answer
Name of Students School (optional)
Your answer
What is the Students PRIMARY instrument/interest? *
(additional choices will be available below)
What Additional Instruments does your student play or want to play?
(you may pick as many as you like)
Please rate your skill level on your primary instrument *
(some experience is necessary to attend this camp for guitarist, bassist, drummers or keyboard players - however "just past beginner" is OK)
Parent /Guardian Information
Parent / Guardian1 Name: *
Your answer
Parent Address *
Your answer
Phone Number: *
Your answer
Parent Email Address *
Your answer
Parent / Guardian 2 Name:
Your answer
Parent/Guardian 2 Address
Your answer
Parent/Guardian 2 Phone Number
Your answer
Parent/Guardian 2 Email Address:
Your answer
Emergency Contact Information
Emergency Contact Name: *
Your answer
Emergency Contact Address:
Your answer
Emergency Contact Phone Number *
Your answer
Emergency Contact Alt. Phone Number
Your answer
Medical and Pickup Authorizations
Does the Student Have any Allergies or Medical Conditions we should know about? *
If the above answer is yes, please explain below
(include any medicines taken, emergency proceedures etc)
Your answer
Who is allowed to pick your child up from classes daily? *
please list all
Your answer
Information and Earplug Waiver
Ear Plugs should be worn whenever exposed to Amplified Music. We provide disposal earplugs at a cost of .50 a pair or student may borrow earphone type hearing protection. Many Students Bring their Own. *
Please acknowledge that you are aware prolonged exposure to amplified music causes hearing loss and that your student has been advised to wear hearing protection at all times while in band room.
Additional Information
Lunch will only be provided on final day of Camp just before the performance.
Students should bring a bag lunch. We can keep items cold for them but do not have a microwave at this time.
Drinks and Snacks are available for purchase.
Extra Guitar Strings, Drum Sticks and Guitar Straps are available for purchase in case of emergency.

A trip to one of the two Ampitheaters is going to take place during camp/date will be given to you at start of camp. A seperate permission slip (provided at start of camp) will be needed for this trip.
A Rock Concert style performance will be given on the final day of camp at 1 pm. Our venue holds about 75 people including the students so bring your family and friends if possible. You Will be impressed with what your student has learned in just 10 days! (*June camp performance to be Saturday at 1 instead of Friday and of course they will have 5 full days to learn - surprisingly still will have a full concert for Saturday)
I hereby electronically sign this and understand I will be required to sign a hard copy on or before the first day of camp.
Parent/Guardian 1: please type your name
Your answer
I hereby electronically sign this and understand I will be required to sign a hard copy on or before the first day of camp.
Parent Guardian 2: please type your name
Your answer
A copy of your responses will be emailed to the address you provided.
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