Summer Camp Registration Form 🎶🌞
Please fill out your details and select your preferred sessions and interests.
Student Full Name
*
First Name
Last Name
Student Age
*
Student Gender
Male
Female
Non-binary
County of Residence
*
Ex: Henry, Rockdale, Clayton, Fulton, etc.
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email Address
*
example@example.com
Volunteer Interest
Yes
No
In-kind
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Relationship
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Allergies or Medical Concerns
Do you give permission for your child to be photographed or filmed for media purposes?
*
Yes, I give permission
No, I do not give permission
Does the student have access to an instrument?
*
Yes
No
Which instrument does the student play?
Student Interests (choose all that apply)
*
Jam Sessions
Creative Exploration
Hanging out with other young musicians
Performance Prep
Music & Art Composition
Confidence-Building
Outdoor Park Meetups
Community Performances
Other
Select the camp weeks/sessions you wish to attend
*
June 30–July 2
July 7–9
July 14–16
July 20–24
July 27–31
August 1 Performance Interest
Donation Amount
prev
next
( X )
USD
Suggested support for one student participating in one week of Henry For Music’s Joy Through Music Community Summer Sessions.Community support contributions help provide… • Community meals & hydration • Guest artists, mentors & workshops • Instrument transportation • Instrument maintenance & supplies • Creative engagement opportunities. *** Families may adjust quantity based on the number of students participating and/or the number of weeks they hope to attend.Flexible participation support is available. No student will be turned away due to financial limitations.
Payment Methods
Choose from one of the PayPal options to
make your payment.
Buy with
Buy with
Submit Registration
Should be Empty: