YMC Registration

(Please use standard capitaization throughout - not all lowercase or all CAPS throughout)

Participant

Last Name *

First Name *

Middle Initial

Preferred First Name *

Mailing Address *

City *

State *

Two Letter Abbreviation

Zip Code *

Participant Email

Date of Birth *

Age *

Sex *

T-shirt Size (Adult) *

Grade (2022-23 year) *

Last School Attended *

Music Teacher *

Years Playing/Singing *

Participation Area *

Instrument or Voice Type *

Piano Participant Questionnaire

Piano Teacher Name *

Piano Teacher Email *

Piano Teacher Phone *

List any piano-related honors, awards, and activities, including solo performances and accompanying experience. *

List repertoire (composer and title) that you have seriously studied and/or performed in the past two years: *

The piano-area classes may be divided into two groups. Please indicate which group you prefer to participate in: *

Intermediate Advanced

Parent/Legal Guardian

Parent/Guardian Name *

Email *

Phone #1 *

Phone #2

Phone #3

Parent/Guardian Name

Email

Phone #1

Phone #2

Phone #3

Tuition/Fees

Camp tuition (Double Room Occupancy - $395, Single Occupany - $495) includes housing, meals, group instruction, teaching materials, & camp t-shirt. Students only need snack and souvnier money, if they desire.

A deposit of $100 is accepted by credit card at the conclusion of this form or paymnet may be mailed to our office in the form of a check or money order. Registration is processed only after deposit is received.

Room Occupancy *

As single rooms are available. If none are, you will be contacted and reimbursed the difference in single and double occupancy room cost.

Room Assignments

Students may identify a prefered roomate below; both students should name each other during registation for greatest clarity.

If a roommate is not identified, students will be paired with another student of the same sex and as near to the same age/grade as possible.

Roommate Preference (Optional)

Be sure they're attending. List first and last name. No names of schools.

Private Lessons (Optional)

All YMC participants receive instruction in a group setting. Private lessons allow camp participants to engage in one-on-one individualized instruction with world-class performers and teachers (all of whom hold doctorates) during camp. Lessons are $30 per half hour and a maximum of two lessons may be requested. Private lessons may be taken in or outside the “performance area,” i.e., a band participant may request a private voice, guitar, or piano lesson.

Number of Lessons

Lesson Instrument/Voice

Emergency Contact

In case parents/guardians named above cannot be contacted.

Emergency Contact Name *

Relationship *

Phone #1 *

Phone #2

Insurance

Insurance Company *

Group No. *

Policy No. *

Cardholder Name *

Cardholder DOB *

Medical

Family Physician Name *

Family Physician Phone *

Allergies, including allergies to foods and/or medicines. If none, enter "N/A." Note that it may be necessary for participants on a specialized diet to bring food items - refrigeration is available. *

If the participant is on any medications please list the medication, dosage, and condition for which it is needed. If none, enter "N/A." *

Are there any over-the-counter medications that you do NOT wish to be administered to the camp participant? If none, enter "N/A." *

Note any physical, emotional, or mental health problems that require special provisions. ***In the case of PHYSICAL disability (i.e., needs for 1st floor accommodations, ramp/elevator access), you must also contact camp directors at (205)-665-6670 to discuss available facility and instructional accommodations as accommodations cannot be guaranteed upon arrival.*** If none, enter "N/A." *

Participation and Medical Release

I, being the parent or legal guardian of the camp participant named above, do hereby grant said camp participant my express permission to participate in all activities of the University of Montevallo Young Musicians’ Camp, including but not limited to, field sports and swimming. I do hereby release and discharge the University of Montevallo, the Young Musicians’ Camp, and all university and guest staff, faculty, and student counselors from any liability should any injuries or damages or loss be sustained to the above named camp participant or their belongings. I authorize staff members of the University of Montevallo Young Musicians’ Camp to provide or seek treatment for the above named camp participant in the event of a medical emergency and guarantee payment of any and all medical charges incurred. I understand the University of Montevallo will attempt to contact one or both of the parents before any emergency medical actions are taken, as able. I grant permission for the above named camp participant to be treated with over-the-counter medications, unless refused herein, for minor illnesses (headache, nausea, earaches, etc.) and be provided basic first aid in the case of minor injuries (scratches, etc.).

Participation and Medical Release Consent *

Yes, both the parent(s)/guardian(s) and participant have read and understand the Participation and Medical Release Statement above and provide consent for participation and any necessary medical care.

Camp Policies

Download Here: YMC Camp Policies and YMC Camp Policies Agreement

Camp Policies and Agreement Consent *

Yes, both the parent(s)/guardian(s) and participant have read, understand, and agree to abide by all YMC Camp Policies and the stipulations described in the YMC Camp Policies Agreement.

Gear-Up Jefferson County

Are you currently a 9th or 10th grade member of the Gear-Up Jefferson County program? Your music teacher and Gear-Up site coordinator informed you if you are in fact eligible. If so, select "Yes" and do not submit the deposit.

If you are NOT a Gear-Up participant, the deposit is required.

Gear-Up Jefferson County *

Yes, I've been told I'm Gear-Up eligible. No

Deposit

After selecting the "Submit Registration & Proceed to Deposit Payment" button below, the information here will be saved and you will be prompted to remit the $100 deposit by selecting the "CashNet Online Payment System" weblink on the next page.

You may instead prepare check/money order for $100 made payable to the “UM Foundation” and mail to: Universty of Montevallo, Young Musicians' Camp, Station 6670, Montevallo, AL 35115.

Registration will not be processed until deposit is received.