2023 Iowa Rock Music Camp Registration Form
Thank you for choosing the Iowa Rock 'n Roll Music Association's Rock Music Camp for the summer of 2023!
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Student Name:
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Student Age:
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Student Education Level:
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Preferred Pronouns:
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Student's Phone Number:
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If you would prefer to be contacted by phone number via a parent/guardian, please specify in the line below. There is a space further down where parent/guardian information can be entered.
Student's Email Address:
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1st Parent/Guardian Name:
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This information is only required if the student registering is below the age of 18, if this does not apply to you please enter "N/A."
1st Parent/Guardian Phone Number:
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This information is only required if the student registering is below the age of 18, if this does not apply to you please enter "N/A."
2nd Parent/Guardian Name:
2nd Parent/Guardian Phone Number:
Emergency Contact Information:
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Please enter the name, relationship to the student, and phone number of the person(s) you would like us to call in the event of an emergency. This can be the same information as either parent/guardian listed above.
Is the above emergency contact a third person you would like us to reach out to if either parent/guardian is unavailable?
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Is there any other contact information you think would be relevant for us to have in case of an emergency (e.g., work, cell phone, landline, etc.)?
Is there any extra information we should know or keep in mind regarding the student? This could be limitations that might prevent the student from doing activities that might be asked of them, food allergies or anything else.
Any information shared here is confidential and is between the student and the instructor(s) they work with. This information will not be shared at any time to those who are not considered need-to-know.
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