ICMC Music Camps
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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
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