Pop Orchestra Band Camp Registration Form

2014 Rhythm Rage Camp Registration Form

Please note that all fields followed by an asterisk must be filled in.

Parent/Guardian First Name*

Parent/Guardian Last Name*

E-Mail Address*

Street Address*

City*

State/Prov*

Zip/Postal Code*

Home Phone*

Student's Name*

Grade*

	6
	7
	8
	9
	10
	11
	12

School

Please list ADA Accommodations needed

Transportation To and From Camp*

Total Registration Fees *

Payment in full by June 5th Payment Type

	Check
	Cash
	Online

Statement of Understanding*

By checking this box I accept and understand that this is a 4 day camp (Mon-Th) beginning June 16th-June 19th from 9:00am-4:00pm. Any portion of the camp that my child can not attend shall be forfeited without refund or credit. I also understand that I am responsible for picking up my child from camp on time unless they are a walker. If I am more than 10 minutes late, I accept and understand that fees will be applied.

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2014 Rhythm Rage Camp Registration Form

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