2025 Music Camp Form

Parent's Name

Address

This address will receive a confirmation email

Phone

Church (if applicable)

Primary Contact Name

Relationship to child

Primary Contact Phone

Additional Contact Name

Relationship to child

Additional Contact Phone

Liability Release

In the event of an emergency, I, the undersigned parent/guardian, understand that all will be done to contact me or the emergency contact named above. However, if neither can be reached, we give full permission to a representative of Westminster Presbyterian Church to seek medical attention in my absence for any child registered on this form. I, the undersigned parent/guardian, hereby assume all risk, known or unknown, for any child registered on this form, in connection with their attendance and participation in Music Camp at Westminster Presbyterian Church. I acknowledge that participation in Music Camp at Westminster Presbyterian Church is voluntary and therefore FULLY RELEASE and discharge Westminster Presbyterian Church, its pastors, employees, directors, and volunteer workers, from any and all liability in connection with any activities carried on at Westminster Presbyterian Church in the Music Camp program.

Parent/Guardian Signature (by typing your name in this space, you agree with the statement above.)

Photography/Video Authorization Release

I, the undersigned, also acknowledge that any child registered on this form, as a participant in Music Camp at Westminster Presbyterian Church, may be photographed or captured on video during the Music Camp program and activities. I hereby grant full permission to Westminster Presbyterian Church to use photographs or videos—in print, electronic, online, or other public media—of any child registered on this form and further release Westminster Presbyterian Church from any and all liability connected with the authorized use of words and image of any child registered on this form.

Parent/Guardian Signature (by typing your name in this space, your agree with the statement above.)

Child's Information

Multiple children may be registered on this form only if each child listed fully matches ALL of the information completed above. Fill out a separate registration for children who do not match this information entirely.

Food Allergy Policy: The church cannot responsibly promise an environment that is 100% free from food allergens. We will take precautions by providing a “safe” snack for children with a medically diagnosed food allergy based on the allergy information you provide below. The snack will be different from the snack provided for the rest of the class.

Child #1

Child # 1 Name

Child # 1 Gender

Male Female

Child # 1 T-shirt size (select your size)

Child # 1 Age

Child # 1 Current Grade

Child # 1 School

Child # 1 Instruments played

Child # 1 How many years playing instrument (s) listed above:

Child # 1 Would your child like to play in the Music Camp Orchestra (must already have played a band/orchestra instrument for at least 1 school year)?

Yes No

Child #1 Allergies/medical conditions/special needs/activity restrictions, etc.

Child # 1 Please describe your child’s reactions to the food allergen you have listed. (i.e anaphylaxis, nausea, vomiting, difficulty breathing, hives, etc.) Food Allergy Policy: The church cannot responsibly promise an environment that is 100% free from food allergens. We will take precautions by providing a “safe” snack for children with a medically diagnosed food allergy based on the allergy information you provide below. The snack will be different from the snack provided for the rest of the class.

Child #2

Child # 2 Name

Child # 2 Gender Male Female

Child # 2 T-shirt (select your size)

Child # 2: Age

Child # 2 Last Grade Completed

Child # 2 School

Child # 2 Instruments played

Child # 2 How many years playing instrument (s) listed above?

Child # 2 Would your child like to play in the Music Camp Orchestra (must already have played a band/orchestra instrument for at least 1 school year)?

Child # 2 Allergies/medical conditions/special needs/activity restrictions, etc.

Child # 2 Please describe your child’s reactions to the food allergen you have listed. (i.e anaphylaxis, nausea, vomiting, difficulty breathing, hives, etc.) Food Allergy Policy: The church cannot responsibly promise an environment that is 100% free from food allergens. We will take precautions by providing a “safe” snack for children with a medically diagnosed food allergy based on the allergy information you provide below. The snack will be different from the snack provided for the rest of the class.

Child #3

Child # 3 Name

Child # 3 Gender Male Female

Child # 3 T-shirt size (select your size)

Child # 3 Age

Child # 3 Last Grade Completed

Child # 3 School

Child # 3 Instruments played

Child # 3 How many years playing instruments (s) listed above?

Child # 3 Would your child like to play in the Music Camp Orchestra (must already have played a band/orchestra instrument for at least 1 school year)? Yes No

Child # 3 Allergies/medical conditions/special needs/activity restrictions, etc.

Child # 3 Please describe your child’s reactions to the food allergen you have listed. (i.e anaphylaxis, nausea, vomiting, difficulty breathing, hives, etc.) Food Allergy Policy: The church cannot responsibly promise an environment that is 100% free from food allergens. We will take precautions by providing a “safe” snack for children with a medically diagnosed food allergy based on the allergy information you provide below. The snack will be different from the snack provided for the rest of the class.

Child #4

Child # 4 Name

Child # 4 Gender Male Female

Child # 4 T-shirt (select your size)

Child # 4 Age

Child # 4 Last Grade Completed

Child # 4 School

Child # 4 Instruments played

Child # 4 How many years playing instrument (s) listed above?

Child # 4 Would your child like to play in the Music Camp Orchestra (must already have played a band/orchestra instrument for at least 1 school year)? Yes No

Child # 4 Current 4th-8th grade students can elect to take a Guitar Class but will need to bring their own guitar. Please check the box below to indicate your child’s interest: Yes No

Child # 4 Please describe your child’s reactions to the food allergen you have listed. (i.e anaphylaxis, nausea, vomiting, difficulty breathing, hives, etc.) Food Allergy Policy: The church cannot responsibly promise an environment that is 100% free from food allergens. We will take precautions by providing a “safe” snack for children with a medically diagnosed food allergy based on the allergy information you provide below. The snack will be different from the snack provided for the rest of the class.

Child #5

Child # 5 Name

Child # 5 Gender male female

Child # 5 T-shirt (select your size)

Child # 5 Age

Child # 5 Last Grade Completed

Child # 5 School

Child # 5 Instruments played

Child # 5 How many years playing instrument (s) listed above?

Child # 5 Would your child like to play in the Music Camp Orchestra (must already have played a band/orchestra instrument for at least 1 school year)? yes no

Child # 5 Please describe your child’s reactions to the food allergen you have listed. (i.e anaphylaxis, nausea, vomiting, difficulty breathing, hives, etc.) Food Allergy Policy: The church cannot responsibly promise an environment that is 100% free from food allergens. We will take precautions by providing a “safe” snack for children with a medically diagnosed food allergy based on the allergy information you provide below. The snack will be different from the snack provided for the rest of the class.

Registration Fee:
$15 per student or $40 maximum per family. Covers the cost of camp t-shirt, camper workbook, daily snack, and other supplies.

Select your cost in the dropdown menu below.

Online payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

2025 Music Camp Form

Description

Please Fix the Following