Bluegrass Camps for Kids

December 31, 1969 - December 31, 1969

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Contact Information

Student Name

Age

Telephone

Mailing Address

City

State

Zip

Parent(s)/Guardian(s) Name

Volunteer

Yes, please contact me to volunteer during the camp.

During the Camp

Yes, I have extra instruments that I can loan during the camp.

Yes, I would like to borrow an instrument during the camp.

Yes, I would like to participate in an optional private lesson

Additional Comments

Class Choices

Please indicate your top five choices in order of importance. We will make every effort to give each student their top 3 choices for the 3 Blocks.

We do not guarantee class choices and instruments, we do try our best to get everyone's first choice of classes and instruments.

Releases

Parent(s) or Guarian(s)

Address

Home Phone	Work Phone
Cell Phone	Email
Emergency Contact	Phone
Family Physician	Phone

Allergies (include food, medicines, animals, insect bites, etc.)

Any other medical or behavioral concerns that you would like the camp staff to be aware of:

Media Release (Please Select):

Yes, I agree to let "Bluegrass Camps for Kids" use a photo/s of my child for promotional use. (The child's name and other information will not be released.)
No, "Bluegrass Camps for Kids" may not use a photo/s of my child for promotional use. (The student will not be allowed to be in th end-of-camp photo).

Closed Campus Policy:

For safety's sake, we have a CLOSED CAMPUS policy. We require that a parent or guardian sign their child out at the end of every day, or provide a handwritten note delivered beforehand. There will be a form and clipboard at the front table for you to sign your child out.

Please select one of the two options:

I agree to sign my child out at the end of every day, or provide a handwritten note beforehand.
My child may leave campus without my signature. I understand that checking this box will release Bluegrass Camps for Kids of any responsibility for my child at the time that is specified as the end of the day on the Camp Form.

Instrument Release:

If my child is borrowing an instrument, I agree to take full financial responsibility if my child incurs any damage to that instrument while borrowing it. If my child is using their own instrument, I agree to take full financial responsibility for the instrument that my child is using. I also agree to release "Bluegrass Camps for Kids" of any financial responsibility if any damage is done to the instrument. If my child is loaning an instrument to the camp, I agree to release "Bluegrass Camps for Kids" of any financial responsibility if any damage is done to the instrument during the camp. I also agree that if there is any damage done to the instrument during the camp, the person using it at the time will be financially responsible for the damage done.

Medical Release:

I hereby consent to emergency treatment, hospitalization, or other medical treatment as may be necessary by a physician, qualified nurse or hospital in the event of an injury or illness. On behalf of the above student, I hereby waive any liability for injuries/illness sustained at this event "Bluegrass Camps for Kids". I also hereby accept legal and financial responsibility for the above student in the event of injury or illness.

By checking this box you agree that you have read the above, and agree to all terms. You also agree that you have read and understand the FAQ page.

Morning or Afternoon Camp Caretaker	Prepare and supervise Snack, keep camp area secure, help students to class, help students and teachers find instruments, and other odd jobs such as making photocopies, making the Camp Concert Program, picking up teachers' lunches, answer parent questions, etc.
Camp Set-Up	Set up chairs and rooms, tune and tag instruments, hang up signs, set-up registration tables, help move instruments to appropriate rooms
Registration	Manage a Registration Table, welcome students and parents to camp and direct to Stations, answer questions
Lunch	Supervise eating and play area so teachers may have a break
Concert Set-Up	Set up chairs, hand out evaluation forms, help students and teacher gather instruments and move to the concert area, type and print concert schedule