WBMG '25 Summer Camp Registration

Music Summer Camp Registration- June 9-20, 2025
Camper Name
Last Name*
First Name*
Middle Name*
MaleFemale
Camper's Information
Address*
City*
State*
Zip*
Phone (if applicable)

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

Area CodePhone Number
Emergency Number #2

Area CodePhone Number
Birth Date*

MonthDayYear
Parent or Legal Guardian Information
Parent/Legal Guardian*
Relation*
Work Phone*

Area CodePhone Number
Cell Phone*

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

Area CodePhone Number
Cell Phone 2

Area CodePhone Number
Email Confirmation
Parents Email (camper confirmation will be sent by email, if left blank it will be mailed)*
Other Information
How did you hear about our camp?*
YesNo
YesNo
All fileds are required below. If nothing applies, please put "NONE" in the box. Thanks.
Any activity the camper should be restricted from?*
Any physical, mental or other condition that would require special attention or medication while at camp?*
List any past medical treatment that would be helpful for us to know.*
List any allergies (ex: bees,peanuts, dairy)*
Any dietary needs that we should know about? (Camp will provide light snack daily; Parents are responsible for child's lunch daily)*
List all medications, both prescribed and over the counter, all medications will be turned into the health officer except rescue inhalers, bring all medication in original containers.*
Payment Information

$125 Registration (1 week minimum)
Camp Fee*
prevnext( X )
1 Week+Processing Fee$128.50

Full 2 Weeks + Processing Fee$253.50
Full 2 week experience!!

Total $0.00
There is a $3.50 processing fee added in the total amount.
Camper Release
Camper Release (List anyone, including parents, to whom your camper can be released)*
- Be certain to enter your email address correctly on the registration form to receive confirmation via email!
By hitting submit and putting your initials, you agree that you are the parent or legal guardian of the above named camper, and are over the age of 18. In case of medical emergency or general medical care, I give consent for medical teatment for the aboved named camper by authorized personnel. The camp carries secondary insurance. I understand that the above named camper will only be released to the names listed above, an update may be done at registration. I certify that my child has my permission to attend camp and participate in all activites. I authorize The Springs to use my camper's picture, testimony, and video in any promotional material(web,print,or media) My child may recieve any e-mails from the camp.
Signature*

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Music Summer Camp Registration- June 9-20, 2025

Camper Name

Camper's Information

Parent or Legal Guardian Information

Email Confirmation

Other Information

Payment Information

Camper Release