~ SJSM's Summer Camp Registration ~
June 26-30, 2023
St. Joseph's School of Music
1619 Dayton Ave. Suite 200
Saint Paul, Minnesota 55104
(651) 690-4364
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First Name (Camper) *
Last Name (Camper) *
Age as of July 1, 2023 (Camper) *
Grade 2022/2023 (Camper)
Preferred pronouns (camper) *
Please choose a primary instrument: *
If applicable, length of study (primary instrument) *
If applicable, name of current teacher (primary instrument) *
Please rank the following choices for secondary instrument. If this section is not filled out completely, camper will be assigned one based on availability:
1
2
3
4
5
6
7
8
9
Piano
Voice
Percussion
Violin
Viola
Cello
Ukulele
Trumpet
Guitar
Clear selection
Which of the following instruments does your camper already own or have access to? (Instruments may be provided as needed at no additional charge)
First Name, Parent(s)/Guardian(s) *
Last Name,  Parent(s)/Guardian(s) *
Phone Number(s) *
Email Address *
Does camper have any medical conditions or special needs we should be aware of? If yes, please explain. *
Does camper have any allergies or dietary restrictions? If yes, please explain. *
Is emergency contact same as parent/guardian? If not, please provide additional names and numbers. *
Approximately what time do you anticipate camper will be dropped off at camp? (not binding) *
Approximately what time to you anticipate camper will be picked up from camp? (not binding) *
Would you like to sign your camper up for a lunch plan for an additional $45? (If not, camper must bring their own lunch.) *
Any other information that may be helpful or we should be aware of: *
How did you hear about this camp? *
I understand that a $150 deposit (of which $100 is refundable) is required to reserve a spot and that the remaining balance is due June 1, 2023. Payments may be made by check, or via the stjomusic.org website (fees apply for credit card transactions). Once both form and deposit are received, you will receive a confirmation email within 1-2 business days.

Completing this form alone will not reserve a spot.  
 *
Required

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities during this camp. I assume all risk and hazards incidental to the activities, and release, absolve and hold harmless St. Joseph's School of Music and all its staff and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from camp sessions. In case of injury to said child, I hereby waive all claims against St. Joseph's School of Music including all faculty, staff, participants, and owners of the premises. 

I ACKNOWLEDGE THAT THIS ELECTRONIC SIGNATURE IS EQUALLY BINDING TO AN ORIGINAL MANUAL PAPER SIGNATURE.

Please type your full name and today's date below as a signature of acknowledgment. 



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