Parent / Guardian Name *

First Name

Last Name

Phone *

(###)

###

####

Participant Name *

First Name

Last Name

Participant Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Birthday *

MM

DD

YYYY

Prior Experience

Does your child have prior experience on any of these instruments?

Guitar

Bass

Ukulele

Piano/Keyboard

Drums

Instrument

Does your child have their own instrument they will bring to camp?

Guitar

Bass

Ukulele

Piano/Keyboard

Drums

Emergency Contact Name *

First Name

Last Name

Emergency Contact Number *

(###)

###

####

Participant Name

First Name

Last Name

Birthday

MM

DD

YYYY

Prior Experience

Guitar

Bass

Ukulele

Piano/Keyboard

Drums

Use same address as first participant.

Use same emergency contact as first participant.