Summer Camp Registration - Step 1

To register for summer camp, please complete the form below and press the "Next" button. If you have any questions or comments, please contact us. We look forward to working with your child at camp!
CAMP SELECTIONS
Location:

(Tuesday July 5 - Saturday July 9, 2011) - $250
CAMPER INFORMATION
Name: First: Last:
School: County:
Grade (Fall 2011): Age: Gender:
T-Shirt size:
Primary Instrument : How long have you played this instrument?
  Do you take private lessons?
  If Yes, who is your private teacher?
List music experience/awards (i.e. School Band/Orchestra, All-County, Solo & Ensemble, etc.):
 
PARENT(S) CONTACT INFORMATION
Name(s): First: Last:
E-Mail Address:
Address:
 
  City: State: Zipcode:
   
Phone Number: Home: Work: Cellular:
EMERGENCY CONTACT INFORMATION
In the event of an emergency, it is important we be able to contact you. If we are unable to reach you by way of the above phone numbers, please list someone we may contact.
Contact(s) Name: First: Last:
Phone Number:
PAYMENT METHOD
How would you prefer to make payment:?
Credit Card
I would prefer to discuss my billing options with an ECMA representative

Copyright © 2011 Encore Community Music Association - All rights reserved.