Children’s Music Camp Registration Form - 2017
Children’s Music Camp Registration Form - 2017
Children’s Music Camp is July 17th through July 21st. Schedule - Monday - Thursday 9:00 to 12:30 pm, and Friday - 9:00 am to 1:45 pm. The celebration is on Friday, July 21st at 7:00 pm
Please complete a separate form for each child attending. Please note - Enrollment maximum is 60 students. Applications will be accepted on a space-available basis.
Price is $105, includes a $20 Non-Refundable Application Fee. $10 discount for additional students in the same family. After July 1st, the tuition fees increases to $125 per child.  * 
Student’s Name  * 
Grade in Fall 2017  * 
Student’s Gender  * 
Address (Street, City, Zip) * 
Parent/Guardian Name  * 
Your Email Address  * 
Home Phone
Cell Phone  * 
Emergency Contact (Name, Relationship, and Phone Number) * 
Student T-Shirt Size  * 
Previous Camp Participant?  * 
If you are new to camp, were you referred by a previous participant?  * 
Name of person referring you
Do you have a friend attending that you would like to be with? (We are not guaranteeing placement with this friend, but we will make every effort to accommodate the request.)
Music Experience (at church and/or school - what type, how long, and indicate current activities)
The goal of our Children’s Music Camp is to provide a fun and positive learning atmosphere for all participants. It is important to clarify our expectations in advance.
Participation is a privilege for those accepted. We expect that each student will be responsible for the following five basic guidelines during the week:
1. Be prepared to learn by arriving on time and attending each day. If you must miss a day due to illness, please call the church office at 949.831.8820 to inform the staff.
2. Treat peers and adults with respect. 3. Be attentive listener & participate in each activity.
4. Use appropriate language & demonstrate proper behavior. 5. Treat all church property and the property of others with respect.
Grouping of students is done by staff with careful consideration of age, grade & level of music/dance experience. It’s not always possible to place friends in the same group. Please support the decisions made by the staff. We will encourage students to meet new friends. We appreciate your cooperation and support.
I have read and understand the Expectations and Guidelines of participation.  * 
I hereby acknowledge and consent to my child being photographed as part of the event and consent to my child’s photo used in any church publications, website, social media, etc.
Age (as of camp date)  * 
Date of Birth  * 
Name of Doctor  * 
Doctor’s Phone Number  * 
Doctor’s Address (Street, City, Zip)
List any physical limitations or medical problems and any allergies: * 
Medical Insurance Company  * 
Policy Number  * 
I hereby give permission for my child, a minor, to participate in the activities/outings of Mission Lutheran Church (MLC) and I have listed any physical impairments that would affect my child’s participation. I authorize MLC, its staff members or counselors to act for me according to their best judgment in any emergency requiring medical attention and give consent for any and all medical treatment deemed appropriate and necessary by the attending medical professional. I hereby waive and release MLC, the staff and counselors from all liabilities for injuries or illnesses incurred during activities/outings.
I hereby acknowledge and consent to the aforementioned Permission Slip, Medical Consent and General Release.
Please type in the box to the right »  * 
Total $
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