Student Registration

Thank you for your payment!

Please fill out all of the required fields below and submit the form to register your child for camp.

Student First Name

Student Last Name

Street Address

City

State

Zip

Student Gender

Student Age

My student is:

Current Grade in School

Instrument

Number of year playing this instrument

School Name

County

School Director(s) Name(s)

Private Lesson Teacher's Name: (if applicable)

Parent / Legal Guardian First & Last Name

Cell Phone

Relationship to student

Describe "Other" relationship to student

E-mail Address Associated with PayPal Account Used to Make Payment

Contact Email Address

Additional Email Address

Students will be housed 2 to a room. All students will be assigned a roommate(s) of the same gender and close in age. Please use the drop down menu to indicate your roommate preferences. Be sure your roommate requests you also! Students will be housed 2 to a room. All students will be assigned a roommate(s) of the same gender and close in age. Please use the drop down menu to indicate your roommate preferences. Be sure your roommate requests you also! Same gender/close to age Someone from my school I have someone specific in mind. (Enter Name Below)

Name of Requested Roommate (They must request you as well).

T-Shirt Size

Enter "Other" Shirt Size

How did you learn about Encore Band Camp?

If "Other", please explain.

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