Registration FormRegistration Form

Summer Camp Registration Form

Jammer'z Information

Jammer'z Name:
Street Address:
City: State: Zip:
Age (as of 06/01/10): Grade (Fall '10):
Birth Date (MM/DD/YY): Sex:

Parent/Guardian Information

Parent/Guardian Name:
Email: Home Phone:
Work Phone: Cell Phone:
Emergency Name:
Emergency Phone:

Select Summer Program for Attendance

Rock Music Day CampInstrumentExperienceExtended
July 5-9, 2010
July 12-16, 2010
NA
NA
Registration Fee included($0)
Total Cost: $

Other Information

List three of your child's favorite bands/artists:
Bandmate Requests (Camper's names):
How did you find out about us?
Additional information that would help ensure proper placement of you or your Jammer:
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