Gloria Dei Summer Music Camp

June 12-16, 2017
Ages 6-12
Musical Skills: Beginning to Intermediate

Registration fee: $225 (by April 5); $300 (after April 5)
(After you submit your registration, you'll be provided with options
to pay the registration fee both online and through the mail.)
Register by June 6, 2017

Child's Name *
Child's Name
Please list any musical classes, lessons, or instrument experience (including current lesson book level) below. If none write "none." (Note: previous experience is not required for the Summer Music Camp.)
For camp-provided t-shirt.
If none write "none."
If none write "none."
Medical Release *
I give my permission for the staff to administer basic first aid to my child (named above) in the event of an injury. I understand that the staff will contact emergency services in the event of a significant injury and all expenses for such emergency services will be paid by me.
Photo Release *
I give permission to Gloria Dei to copyright and use photographs/videos taken at the Summer Music Camp of the minor designated above in any manner or form for any purpose lawful at any time. I waive any right that I may have to inspect or approve the finished product or written copy, that may be used in conjunction therewith, or the use to which it may be applied.
Parent/Guardian Name *
Parent/Guardian Name
Parent/Guardian Address *
Parent/Guardian Address
Parent/Guardian Phone Number *
Parent/Guardian Phone Number
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Phone Number *
Emergency Contact Phone Number
Alternate Pickup Name
Alternate Pickup Name
Alternate Pickup Phone Number
Alternate Pickup Phone Number
Permission *
I give permission for my child to attend the Summer Music Camp. I understand that this registration information will only be used by Gloria Dei and will not be shared with or sold to any other institution or company.