World Music Camp

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Participant Information

Click the "+" to add a participant.

PLEASE NOTE: If you are a CBE member hoping for FREE tuition, you MUST be logged in.

* Name

First and Last

* Age on June 7

Grade (if applicable)

* Instrument played

Years of Experience

Rank your skill:

* Music Camp Tuition ($200)

Music Camp Tuition

Allergies

Medications

Only list those that need to be taken during camp

* Parent First Name

Or self if you are an adult

* Parent Last Name

Or self if you are an adult

* Email

Cell Phone Number

Home Phone Number

Work Phone Number

Address

Address Line 2

City

ZIP

Parent 2 First Name

Parent 2 Last Name

Parent 2 Email

Parent 2 Mobile

Parent 2 Work Phone

Does Parent 2 have a different address?

NoYes

Parent 2 address

Parent 2 City

Parent 2 State

Parent 2 Zip

Emergency Contacts

If camper is a child, these can be parents. If camper is an adult, please indicate who you would call in case of a medical emergency.

Emergency Contact 1

Emergency Contact 1 Phone

Relation to Emergency Contact 1

Emergency Contact 2

Emergency Contact 2 Phone

Relation to Emergency Contact 2

Emergency Release

In the event of an emergency, I hereby give permission to Congregation Beth Evergreen or its agent to hospitalize and/or secure proper treatment for my camper as named in this registration form.

Photo and/or Video Release Authorization Form

Photos and/or videos will be taken of campers, camp activities, etc. I authorize the use of photos and videos of my camper (listed above) for news releases, the synagogue website, Facebook, school-related video and slide presentations, marketing purposes, Shofar, Newsletter etc.

Digital Signature

Today's Date

Total