SIPC Summer Music Camp Registration Form
Music Camp is June 5-9, 2017 and meets each day from 9:00 a.m. - 12:00 p.m. Music Camp is open to children entering grades 3-8 in the 2017/2018 school year. Please fill out one form per child. Registration is not complete until your payment of $35.00 has been received. Deadline to register is May 18.
Parent's first name: *
Your answer
Parent's last name: *
Your answer
Child's first name: *
Your answer
Child's last name: *
Your answer
Parent's Cell Phone: *
Your answer
What grade will your child enter in August, 2017? *
Emergency Phone: *
Your answer
Home Phone: *
Your answer
Email address: *
Your answer
Mailing address: *
Your answer
Church you attend (if applicable):
Your answer
Each child will be enrolled in one elective for the entire week. Choose two electives below. Offerings will depend on staff availability. Some classes will be limited in size.
Elective Choices *
Art Exploration (drawing, painting, and more)
Guitar (must supply own instrument)*
First Choice
Second Choice
If you selected Guitar Class, what is your child's level of experience?
If you selected Handbells, what is your child's level of experience?
If you selected Recorder, what is your child's level of experience?
Registration Information
Are you interested in receiving information about a scholarship to music camp? *
What is your child's T-shirt size? *
T-shirts may not be available in cases of late registrations.
Does your child suffer from any allergies or take any medications? *
If there are no allergies or medications, please answer "No". If you answer "Yes", please give a detailed description of the allergy and/or medications.
Your answer
Does your child receive any special services at school or at home? *
If your child does not receive any special services, please answer "No". If your child does receive special services, please describe the services your child receives and indicate whether you or your child's school provides for those services.
Your answer
Special Activity Authorization
I hereby grant permission for my child to participate in all program activities of Music Camp at Sea Island Presbyterian Church during the summer of 2017 and to receive any medical, surgical, or first aid attention that might be required in the event of accident or illness. This is affirmed by my initials entered below which constitutes my electronic signature.
Initialed: *
Your answer
Date: *
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