*Age: *Gender *Date of Birth Ethnicity (optional)
*Parent's Name: *Does Student Reside in the U.S. Virgin Islands?
*Mailing Address: If NO, please state where student resides.
*State: *Zip Code:
Work Phone (Area Code and Phone):
Home Phone (Area Code and Phone):
*Cell Phone (Area Code and Phone):
*Confirm Email Address:
*How did you hear about us?:
*Emergency Contact Person(s):
*Relationship to Student:
Emergency Contact's Work Phone:
Emergency Contact's Home Phone:
Emergency Contact's Cell Phone:
*DESIGNATED PICKUP PERSON(S)
Name of Pickup Person(s):
(Each pickup person MUST supply an ID for G-Clef files)
*SUMMER MUSIC CAMP
T-SHIRT SIZE SELECTION
NEW this year!!! FREE T-Shirt!!!
FREE Summer Music Camp T-shirt
(please select one size for the student)
Proof of Insurance Required
Must Provide Insurance Card at Registration
Insurance can be provided through G-Clef
G-Clef Campers Insurance: PGU Insurance ($20/per child)
If you are purchasing camp insurance for your child, please add $20.00
Does your child have any allergies? (please select)
If yes, please explain:
Does your child have any special needs? (please select)
If yes, please explain:
In accordance with Federal Law and U.S. Department of Agriculture policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age, or disability. To file a complaint of discrimination, write USDA Director, Office of Civil Rights, 1400 through local relay or the Federal relay at (800) 877-8339 (TDD) or (866) 377-8642 (relay voice users). USDA is an equal opportunity provider and employer.
*BUILD YOUR CHILD'S SUMMER MUSIC CAMP BY CHOOSING:
Camp Days, TWO-HOUR Group Time Blocks, Instrument(s), and Camp Weeks (Check ALL that Apply)
Students, ages 4 to 6, learn through Music Exploration, which includes all instruments (instruments vary per location).
SELECT Music Class Block Time(s) SELECT Instrument(s) to learn during Block 1 and/or 2 SELECT Weeks to Attend
06/20-06/24 06/27-07/01 07/04-07/08 07/11-07/15 07/18-07/22
*CAMP ENROLLMENT DATES
June 20, 2022 to July 22, 2022 (5 Weeks)
Please enter your child's STARTING and ENDING DATES AND the TOTAL NUMBER OF WEEKS to be enrolled in camp.
*Camp Start Date: Camp End Date:
*Total Number of Weeks of Enrollment:
*I, Parent/Individual Over 18, have read, understand and ACCEPT the IMPORTANT NOTES, TUITION PAYMENT REQUIREMENTS, AND POLICIES listed below. I ACCEPT responsibility for all charges that may be incurred. I AGREE to all policies, terms, statements and payment terms of G-Clef Music Academy's 2022 Summer Music Camp agreement. I ALLOW G-Clef Music Academy full promotional use of photographs and videos taken of the above registered student at G-Clef Music Academy’s summer camp and events.