Freestyle Camp M&M

Camp Music & Math (M&M)
Student Information
Student's Name

First Name Last Name
Are you currently a Freestyle Percussion Student?

Yes No
Birth Date

Month Day Year
Grade
Gender

Male Female
Race

Asian or Pacific Islander Black or African American Hispanic or Latino Native American or Alaskan Native White or Caucasian Multiracial or Biracial Other
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent/Guardian Information
Name

First Name Last Name
Home Number
Cell Number
E-mail
example@example.com
Household Income
Emergency Information
Emergency Contact's Name

First Name Last Name
Relationship
Phone Number
Alt. Phone Number
Does the student have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is the student prescribed an inhaler? If yes, please explain any instructions.
Do you require a scholarship interview?

Yes No
What's the best number to call to schedule a scholarship interview?
Payment Preference

Online In Person
Guarantee your spot! Registration is first come first serve. A $50 deposit must be paid to be considered registered. In-person payment can be made at The Freestyle Percussion Foundation 2010 Old Springville Rd Suite 124 Birmingham, AL 35215. Please call ahead 205-306-6868.
Registrations Fees
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Deposit (Non-Refundable)
$ 50.00

Camp M&M (Early Bird Registration) July 5 - July 29
$ 250.00

Total

$ 0.00
Confirmation BY SUBMITTING APPLICATION, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
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Camp Music & Math (M&M)