MusicMakers! Camper Registration

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Must Be Completed Before First Day of Camp

Email *

Camper's Full Name (Last, First) *

Camper's Mailing Address (Street, City, State, Zip) *

Camper's Last School Attended *

Camper's Contact Email Address *

Camper's Height in inches: *

Camper's Primary Email *

Camper's Primary Contact Phone # *

Guardian 1/ Mother's Name (Do not list if Mom does not have custody)

Mom's Contact Phone #

Guardian 2/ Father's Name (Do not list if Dad does not have custody)

Dad's Contact Phone #

Non-Parent Emergency Contact Name & Relationship *

Non-Parent Emergency Contact Phone # *

Camper's Gender *

Male

Female

Other:

Camper's Date of Birth

YYYY

Camper's Last Completed Grade as of June 1 this year *

Kindergarten

Required

Camper's Musical Experience (Select all that apply): *

school choir or church/temple choir

school orchestra

school band

private lessons on any instrument

dance lessons

Family Music Making

None but likes music

Other:

Required

Which instruments do you NOW PLAY or HAVE YOU PLAYED WITH INSTRUCTION in the LAST 3 YEARS? (List all that apply) *

Grouping Requests: (If desired, list names of other registered campers your child prefers as pals. Requests will be honored whenever possible, but are subject to space and equipment availability.)

Camper's T-shirt Size *

Are you a returning camper? *

If you are a returning camper, how many SESSIONS have you attended in the past?

Which Session(s) will you attend? (check all that apply) *

Session 1 (3 weeks- June 17-July 3)

Session 2 (2 weeks- July 8-19)

Both Sessions 1 & 2 (5 weeks)

Single Week(s)

Required

If attending single week(s), which single week(s) will you attend? (check all that apply) (FYI- Camp is closed June 19 & July 4. If one of these falls on Saturday, camp is closed the Friday before. If one falls on Sunday, Camp is closed the following Monday.)

week 1 (begins Mon. June 17)

week 2 (begins Mon. June 23)

week 3 (begins Mon. July 1, closed July 4-5)

week 4 (begins Mon. July 8)

week 5 (begins Mon. July 15)

Do you need regular or extended hours? *

Camper's Allergies, Special Needs, or Medical Conditions (Type NONE if this does not apply) *

Camper's Health Insurance Company (type NONE if child has none) *

Camper's Health Insurance Group #/ ID # (type NONE if child has none) *

MUSICMAKERS! RELEASE (MANDATORY- The Media Release is required for all Campers and Volunteers in order to participate in MusicMakers! Summer Camp.) *

I agree to allow my child/volunteer to be recorded (audio-taped, videotaped, etc.) while participating in MusicMakers! activities this summer. Such recordings may be used to publicize camp events in future newspapers, flyers, websites, radio, television, etc. I hereby release and agree to indemnify and hold harmless MusicMakers!, Inc. and all instructors against any and all claims resulting from participation in this program, with my knowledge that by participating in this activity I assume risk of injury and or illness. I also hereby give permission to MusicMakers!, Inc. to use and display any photographs or videos taken of me / my child, which may be forwarded to newspapers and other publications in which the media would be associated with MusicMakers!. I also hereby give my permission for my son / daughter to receive any necessary medical treatment for injury or sickness outpatient care and / or in-hospital treatment.

Required

Registration and Tuition Information (Please check all of the boxes once you have read all of the information.) *

Tuition is paid at the Coral Springs Gymnasium or online at coralsprings.org/recreation. Extended hours are paid on site weekly; see Camp Handbook for current rates.

An $18 per week per child cash Supply Fee is due at Orientation or Day 1. The entire session supply fee is due on Day 1 (not a weekly installment). See Camp handbook for full details.

Optional hot lunch is also available for $50 per week or $11 per day: McDonald's Monday; Taco Tuesday; Wendy's Wednesday; KFC Thursday; Pizza Friday! Pay on site by the week or by the day.

MusicMakers! believes in community service! Each summer we choose a charity and donate our recital and finale concert entry donations to that cause. To date, we have raised over $6.000 to help the Donice Rufus Music Education Scholarship Fund; Make-A-Wish Foundation; Humane Society; Alex's Lemonade Stand; the CSHS Steven Hoyos Memorial Band Fund; and Wounded Warrior Foundation.

Visit www.musicmakerscamp.com for the Camp Handbook and frequently asked questions. Thank you!

Required

MusicMakers! Transportation Designee (OPTIONAL)

Check here is someone other than the mother/father will transport child to/from camp. If not, skip to the next item.

TRANSPORTATION DESIGNEE (OPTIONAL). List full legal name(s) of anyone transporting camper from camp during the sessions you choose. Designee MUST have photo ID or child will not be released to them. (Type NONE if only the guardians will be transporting the camper.) *

What is your PASSWORD, in case someone not listed on your transportation designee list must pick up your child due to an emergency? (We will ask for this password and a drivers' license upon pickup. You must call or text us with the name of the person picking up and they must know the password, or child will not be released.) *

In case of questions, what is your phone number at pickup time? *

How did you hear about MusicMakers! Summer Camp? *

Word of mouth

Coral Springs Fun Guide

met Ms. Nicole or a staff member

Saw MusicMakers! Vehicle

Internet search

returning camper

Other:

Required

A copy of your responses will be emailed to the address you provided.

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