RockStar Experience Camp

Student Name *

Student's Address *

Phone Number *

Student Email Address:

Age of Student *

Name of Students School (optional)

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)

Parent /Guardian Information

Parent / Guardian1 Name: *

Parent Address *

Phone Number: *

Parent Email Address *

Parent / Guardian 2 Name:

Parent/Guardian 2 Address

Parent/Guardian 2 Phone Number

Parent/Guardian 2 Email Address:

Emergency Contact Information

Emergency Contact Name: *

Emergency Contact Address:

Emergency Contact Phone Number *

Emergency Contact Alt. Phone Number

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)

Who is allowed to pick your child up from classes daily? * please list all

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.

PERFORMANCE DAY

A Rock Concert style performance will be given on the final day of camp at 2 pm. Our venue holds about 200 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!

Signatures

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

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

Rock Summer Camp