Band Camp Application

Camp	Camp Dates	Application Period

General Info

First Name

Last Name

Date of Birth

Gender

Email Enter a valid email address

Phone Number

School

Grade Number

Band Director Email Enter a valid email address

Instrument

Jazz Instrument (optional)

Shirt Size

Staying on campus

Preferred Roommates (Up to 6)

Street Address

City

State

Zip

Parent/Emergency Contacts

Mother Name

Mother Job

Mother Phone

Father Name

Father Job

Father Phone

Em. Contact Name

Em. Contact Phone

Medical Information

Do you give permission for the camp nurse to administer Tylenol, Tums, Benadryl or other formulary approved over-the-counter medications?

List any health problems or medication that will assist us in the care of your child

Health Release

I, the undersigned, do hereby grant permission for the camp staff and nurse to administer first aid and/or treatment for minor accidents and sicknesses.

Type your name below (parent, guardian, or sponsor)

Accident Insurance

Campers are insured while on the Itawamba Community College Fulton campus. This is a supplement policy and covers accidents only. If a camper is covered under an existing health policy, the existing policy must be claimed upon first. Inform personnel of any special medical conditions or drug allergies. The camp insurance does not include to and from campus.

Insurance Company

Insurance Group

Insurance ID

Insurance Subscriber

Insurance Type

Registration Form/Class Schedule

Each camper will be required to carry no fewer than seven hours and no more than nine hours per camp day. Campers will be arranged as nearly as possible according to preference. Note: Each camper must bring his/her own instrument. All campers are required to participate in band. All color guard students must bring their own equipment. All drum majors and color guard students are required to sign up for all drum major and color guard classes. Consult the application booklet and your band director when completing the class schedule.

Select the courses you want to take from the Course Description pages.
Look at the Class Offerings pages to determine which period the course is offered.
Fill in the schedule below with the classes you would like to take.
Be sure that you are registered for at least seven hours per day (includes the 4 hours of band that is required by all campers.
Junior High campers are not allowed to take High School courses.

Some indicated courses meet during multiple periods. If you wish to enroll in these courses, make sure to select the same course for their respective periods.

Band Camp Fee

A $50 non-refundable deposit accompanying application with the balance due on or before ?. I, the undersigned, approve the application for enrollment, adhere to the policies at the ICC Summer Band Camp and assume responsibility for payment of the total camp fee and any incidental expenses incurred by the applicant. I understand that the camp fee includes all camp expenses (except travel, laundry, and individual personal expenses). I further agree that no refund will be given for late arrivals, early departure or dismissal of the applicant at any time for violation of camp rules and/or regulations of federal, state or local laws.

Type your name below to sign application (parent, guardian, or sponsor)

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