Registration Form
Bach 2 Basics Summer Camp 2011 Registration Form
Child's First Name:
Child's Last Name:
Current Age:
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
Child's Musical Experience (is he/she taking music lessons, for how long, etc):
What would you like to see your child take away from this camp?:
Does your child have any allergies?
Yes
No
If yes, please list and briefly describe them here:
Does your child have any medical condition or injuries that will restrict or prevent him / her from participation in physical activites?
Yes
No
If yes, please list and briefly describe them here:
Full name of primary legal guardian (to be called first in case of emegency):
Preferred Email Address:
Preferred Phone Number:
Full name of primary legal guardian (to be called second in case of emegency):
Preferred Email Address:
Preferred Phone Number:
