Brass Camp 2021: Curtain Call Registration Form
Please fill out the following form to register for Brass Camp 2021: Curtain Call! The registration deadline is June 16th, 2021.

For additional information about Brass Camp, please visit: https://www.michaelbucksteinmusic.com/brass-camp.

If you have any questions, comments, or concerns, please reach out to Michael Buckstein at michaelbucksteinmusic@gmail.com
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Student Name *
Student Birth Date *
MM
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DD
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YYYY
Instrument *
2021-2022 School Grade *
What school do you attend? Please include name of the school and the district. (Ex: O'Block Junior High - Plum Borough) *
Band Director *
Band Director Email *
Private Lesson Instructor
Private Lesson Instructor Email
Parent/Guardian Name *
Parent/Guardian Home Phone (Please write in the following format with dashes: xxx-xxx-xxxx) *
Parent/Guardian Cell Phone (Please write in the following format with dashes: xxx-xxx-xxxx) *
Parent/Guardian Email Address *
Home Address *
Please select the ensemble that you will you be participating in *
Please list your performing experiences in school (concert band, jazz band, marching band, etc). *
Please list your playing experiences outside of school (private lessons, church, PMEA festivals, community ensembles, etc). *
Please select any rehearsals you need to miss. *
Required
Are you referring a friend? If so, please list the name(s) of the friend you are bringing to Brass Camp for the first time.
Is this your first time at Brass Camp? Is there any particular person who referred you to Brass Camp? If yes, write their name below.
Are you a student in the senior high ensemble who would like to be involved in a mentorship program and assist with the junior high ensemble? If so, please apply for the Brass Camp Peer Mentorship Program. Duties would include helping the junior high ensemble students with their parts and acting as a positive role model. If you would like to be considered, select yes. If you do not wish to be considered, select no. *
If the answer to the above question was yes, please write a paragraph explaining why you would like to be considered to assist with the junior high ensemble. You will be contacted as to whether or not you have been accepted into the Brass Camp Peer Mentorship Program.
PUBLICITY RELEASE: I give permission to the staff of Brass Camp 2021 to record, film, photograph, and audiotape my image, likeness, and performance while at Brass Camp rehearsals or performance(s) and to display, publish, or exhibit this media without limitation, reservation, or compensation. *
PAYMENT
Registration for this year is $60.00. The Brass Camp experience includes: five rehearsals, concert, custom music arrangements, guest clinician workshop, and a commemorative poster. This registration is non-refundable after June 16th, 2021 and can be paid by check made out to "Michael Buckstein" or Venmo to "@Michael-Buckstein".

Checks can be mailed to:
Michael Buckstein
503 Rockland Drive
Pittsburgh, PA 15239

By signing electronically below, I (parent/guardian) acknowledge that I have read and understood all the information presented in the Brass Camp 2021 registration form. By signing this agreement, I wish to enroll my son or daughter in Brass Camp 2021: Curtain Call. *
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