2016 Summer Music Camp Registration
Jacksonville School of Music
Select Camp: *
Camper's Information
The following information is about your child, the camper, who will be attending our Summer Music Camp!
Name (First and Last)/Nickname *
Your answer
Date of Birth: *
MM
/
DD
/
YYYY
Age & Grade *
Your answer
Gender *
Address (street, city, state, zip) *
Your answer
Parent/Legal Guardian Information
The following is contact information of the parent(s)/legal guardian(s) of the camper.
Mother/Legal Guardian Name: *
Your answer
Mother/Legal Guardian Cell #: *
Your answer
Mother/Legal Guardian Home #:
Your answer
Mother/Legal Guardian Business #:
Your answer
Mother/Legal Guardian E-mail:
Your answer
Father/Legal Guardian Name:
Your answer
Father/Legal Guardian Cell #:
Your answer
Father/Legal Guardian Home #:
Your answer
Father/Legal Guardian Business #:
Your answer
Father/Legal Guardian E-mail:
Your answer
Special Instructions
This section provides any special instructions that we need to have for your camper!
Others authorized to pick-up your child (specify name and relationship to child):
Your answer
Does your child have any special needs? If so, please list and be specific: *
Your answer
Does your child have any known allergies? If so, please list: *
Your answer
2016 Summer Music Camp - Jacksonville School of Music
How/where did you hear about the Jacksonville School of Music?
Your answer
Choose your child's small group classes by selecting 1-5 in order of preference:
We make every effort to put student's in their top three choices. However, if their choices are not available due to overlapping lesson times, we will supplement with their next choices (4 or 5) if necessary.
Drums *
Guitar *
Violin *
Vocal *
Piano *
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