CAMP ROCK
Music Camp
2011
(July 11-12-13-14) &/or (July 18-19-20-21)
REGISTRATION FORM
(4-9 Year Olds)

Child's Full Name:

Child's Date of Birth:

Age on July 1, 2011: (Years & Months)

Boy/Girl:

Your Email:

Home Phone:

Cell Phone:

Mother's Name:

Father's Name:

Address:

City:

Zip:

Allergies:

Days Enrolling In Music Camp:
July 11-12-13-14
Time Preference:
(Check both if no preference)

M-T-W-Th (PM) - 12:30 to 3:30
1st Choice
2nd Choice

July 18-19-20-21
Time Preference:
(Check both if no preference)

M-T-W-Th (PM) - 12:30 to 3:30
1st Choice
2nd Choice

Please send $100 post dated check for July 1
More Information: (If Needed)