Summer Camp Registration Form

Summer Music Camp Registration

Join us for a fun musical camp this summer!! *Bring a water bottle and a snack
Student Information
First Name
Last Name
Gender
Address
City
Postal Cose
Birth Date

MonthDayYear
Grade entering in the fall
Please select your desired camp
Parent or Legal Guardian Information
Parent/Legal Guardian
Relation
Cell Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
Parent /Legal Guardian 2
Relation 2
Cell Phone 2

Area CodePhone Number
Work Phone 2

Area CodePhone Number
Emergency Contact Info
Emergency Contact Name(if parent or guardian is not avaliable)
Emergency Number

Area CodePhone Number
Emergency Number #2

Area CodePhone Number
Email Confirmation
Parents Email (student confirmation and camp details will be sent by email
Health Information
List any allergies (ex: bees,peanuts, dairy)
Is there anything else we should know about your child?
Student Photo Release
I agree that photos of my child can be taken and used for social media purposes
Payment Information

Your spot will be saved in camp upon receipt of the selected camp fee sent by e-transfer to blkmtnmusicschool@gmail.com. You will be contacted by email within 2 business days to confirm your registration. 5-Day Music & Art Camp Fee: $150, 4-Day Music & Art Camp Fee: $120
Should be Empty:

Summer Music Camp Registration