Summer Jazz Camp 2023 Summer Jazz Camp 2023 Summer Jazz Camp at Friday Musicale! Camp runs daily from July 31st - August 4th. 5th grade through high school welcome to apply, complete registration and $250 tuition required to reserve your space at camp. Please inquire for scholarship availability - mail@fridaymusicale.com or 904-355-7584. Camper Information First Name * Last Name * List Instrument or Vocal * Email * Address * Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal What grade will Camper be in Fall 2023? * 5th 6th6th 7th 8th 9th 10th 11th 12th T-shirt Size * Adult Small Adult Medium Adult Large Adult XLarge Adult XXLarge Parent / Guardian Information (for High school students only) Parent First Name Parent Last Name Parent's Email Phone Cell Phone Address same as above? Yes No Address Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Camper Medical Information (for Highschool Students) Doctor's Name / Practice Doctor's Phone Special Needs, Allergies, Medical Conditions, etc. Health Insurance Provider Health Insurance Contract & Policy # Emergency Contact First and Last Name Must be someone other than Parent Emergency Contact Phone Emergency Contact Cell Phone Driver Pick up Information For students who are not driving themselves, only registered names listed in the Parent/Guardian, Emergency Contact, and Carpool Information Fields will be allowed to pick up campers from Camp. In order for an individual to pick up campers from Camp, we must have written permission from the Parent/Guardian and said individual will may have to show a picture ID. This form serves as written permission for picking up students after camp each day. Carpool Driver Name Carpool Driver Phone Carpool Driver Cell Phone Media Release: I hereby authorize the photographing/filming of myself/my student. We will not release names of any camp attendees. I agree that Friday Musicale may use such photographs/films of me/my student with or without his/her name for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. In addition, I waive the right to inspect or approve the finished product, including written and electronic copy, wherein my/my student’s likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photographs/films. I also agree that such photographs/films shall be the property of Friday Musicale. Media Release Agreement * Yes No Waiver & Other Agreements In consideration of the cultural and educational benefits which I/my student will receive as a result of the Friday Musicale, I hereby agree to hold Friday Musicale, all of its directors, officers, administrators, and employees, blameless for any bodily injury and/or property damage which might be incurred by me/my student as a result of the aforementioned activities. I authorize Friday Musicale and/or its representatives to arrange for any necessary emergency treatment. Yes Friday Musicale provides equal opportunity to all without regard to race, color, ancestry, national origin, gender (including pregnancy), sexual orientation, marital status, religion, age, disability, gender identity, results of genetic testing, or service in the military. I acknowledge that my registration is not complete or binding until the Friday Musicale staff has reviewed the registration requirements and processed the registration fee. I acknowledge that refunds will not be given for missed days due to illness or absence for any reason. Even if I/my student is unable to attend camp for a single day, once registration is complete or payment has been processed, refunds will not be given for any reason. By completing this form and adding my electronic signature, I agree to all requirements of this form. Electronic Signature * Date * If you are human, leave this field blank. Next - Payment Info
