ICMC Music Camps
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New Student Registration
Returning Student Registration
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Returning Student Registration
Parent/Guardian Information
First Name
*
Last Name
*
Street Address
*
Apartment, suite, etc
City
State/Province
ZIP / Postal Code
Scholarship Application
Will you be applying for a scholarship?
*
Yes
No
Annual Income (for Scholarship Application)
Number of People in Household (for Scholarship Application)
Student Information
First Name
*
Last Name
*
Age
*
What school will you attend next year?
*
How many years have you been playing your instrument?
*
Do you take private lessons?
*
Yes
No
Name of your private teacher?
Please list any allergies.
Will you need us to administer medication during camp?
Student 2 Information
First Name
Last Name
Age
What school will you attend next year?
How many years have you been playing your instrument?
Do you take private lessons?
Yes
No
Name of your private teacher?
Please list any allergies.
Will you need us to administer medication during camp?
Student 3 Information
First Name
Last Name
Age
What school will you attend next year?
How many years have you been playing your instrument?
Do you take private lessons?
Yes
No
Name of your private teacher?
Please list any allergies.
Will you need us to administer medication during camp?
Student 4 Information
First Name
Last Name
Age
What school will you attend next year?
*
How many years have you been playing your instrument?
Do you take private lessons?
Yes
No
Name of your private teacher?
Please list any allergies.
Will you need us to administer medication during camp?
Emergency Contact Information
Emergency Contact #1
*
Emergency Contact #1 Phone
*
Emergency Contact #2
Emergency Contact #2 Phone
Photo/Video Release
Permission: The Iowa Chamber Music Collective and its agents has my permission to use my or my child's photograph or video to publicly promote the camp. I understand the photos or videos may be used in print or digital publications, online publications, websites, social media, and presentations. I also understand that no royalty, fee, or other compensation shall become payable to me or my children by reason of such use.
*
Yes, we would like to support ICMC to keep the program running.
No, we would like to opt out.
The Iowa Chamber Music Collective is a nonprofit organization, a 501c(3). We may take photos and/or videos during our music camps to help promote our camps online or on print media. We may also submit photos when applying for grants and funding. We appreciate your support!
Payment Information
Do not fill out if applying for scholarship.
How many students are you registering? (SKIP SECTION if applying for scholarship)
1 Student
2 Students
3 Students
4 Students
Total Due
Sign & Date
Name
*
Date
Register