Grade Level Entering in Fall 2008

Street Address

City State Zip

Previous Music Experiance

School Name/District: Music Educator Name:

Camp Participant Enrollment

Participant T-shirt Size: Kids S Kids M Kids L Adult S Adult M Adult L

Participant Enrollment:
K-2; 9am-1pm K-2 w/ extended care; 9am-3pm 3-10; 9am – 3pm

How did you hear about TCGC summer music camp? Check any that apply
Currently a TCGC Singer TCGC website
Music Educator/specify
Printed Material /specify

Parent/Guardian Info
Last Name: First Name:

Street Address

City State Zip

Home Phone Work Phone

Cell Phone Email Address

Preferred Contact

Second Parent/Guardian Info
Last Name: First Name:

Street Address

City State Zip

Home Phone Work Phone

Cell Phone Email Address

Preferred Contact

Camp Participant Medical Information:

Allergies:

Current Medications (Prescription and OTC):

Check any that apply:
History of Fainting/Dizziness Seizures Recent Surgeries:
Dates of Any Occurrence:

List any contagious childhood illnesses your participant has had

Date of Most Recent Immunization:

List Vaccines Administered:

Insurance Information:

Camp Participant Name on policy:

Policy Holder Name: Provider Name:

Policy/ID Number: Group Number:
*** Please attach a copy of both the front and back side of your current insurance information. You may also bring your current insurance information with you on the first day of the camp, and TCGC staff will make a copy for you.

Emergency Contact Information:

Emergency Name: Phone:
Emergency Relationship to Participant

Checking the agree to these terms box below, I give my permission for to attend the Twin Cities Girls Chorus 2008 Summer Music Camp, and certify that I am this child’s parent/legal guardian. I certify that all necessary and required information has been provided regarding this child, and that all given information is accurate. I also give my permission to the staff/volunteers of the Twin Cities Girls Chorus to administer any medical care deemed necessary to the health of my child, including the contact of emergency medical professionals/services.

I will be paying for the camp by:
Pay By Check
Pay By Credit Card Online (PayPal)

Agree to all terms in this contract check box