Jazz Camp 2023 at Friday Musicale

Camper Information

First Name *

Last Name *

List Instrument or Vocal *

Email *

Address *

Address

City

State/Province

Zip/Postal

What grade will Camper be in Fall 2022 *

T-shirt Size *

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

City

State/Province

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 *