REGISTRATION INSTRUCTIONS If you have any questions, please call us at: 203-925-9660 or 1-888-MYLESSON To Enroll: 1) Print and complete the attached forms. 2) Enclose a deposit check of $150 per camper made out to "Music Teachers Network". (Deposits are non-refundable after May 31 st ) 3) Mail everything to: Music Teachers Network 10 Bona Vista Terrace Shelton, CT 06484 FULL PAYMENT FOR CAMP IS DUE BY JUNE 30 th If you choose the upgrade option, specific Guitar Choices/Selections will be sent to you in early July.
REGISTRATION FORM Child s Name Birth date / / M F Grade Entering School Guitar Experience Level: Camp Choices: (see website for descriptions) Guitar Building Camp $399 for 1 week, supplies included Optional Color Choice Upgrade $76 Rock Camp Jr (5 10 yrs old) $140 for 1 week Parent/Guardian Information Parent #1 Name Home Phone Home Address City, State Zip Cell # Work Number Email Parent #2 Name Home Phone Home Address City, State Zip Cell # Work Number Email Emergency Information: Local contacts other than Parents who have authorization to pick up child from camp. 3) Name Allergies and Food Intolerances NO known allergies YES, my child is allergic to My child has food intolerance to Due to my child s food allergies or food intolerances, I understand I must provide a snack for him/her. Emergency medications Other Medical Issues Child s Doctor Doctor s Phone RELEASES If parent(s) or legal guardian(s) cannot be reached in the event of an emergency I do hereby appoint the staff of Music Teachers Network to act in my (our) behalf to administer first aid treatment and/or authorize unexpected medical, dental or surgical care and hospitalization for my child. I give Music Teachers Network staff permission to release my child to the contacts listed above. These people have my permission to make decisions as to the welfare and health of my child. Date Signature of Parent or Guardian Parent s Name please print 1) Name 2) Name
POLICES AND REGULATIONS PHOTO, VIDEO & AUDIO RELEASE Music Teachers Network llc (M.T.N.) requests permission for the publication of photos, videos and/or audio recordings of your child. Camper photos may be selected for use on promotional materials, in our newsletter, or on the M.T.N. website. Video footage and audio recordings may be posted on the M.T.N. website or on the M.T.N. Facebook page or YouTube Commercials. Parent and camper must understand and agree that these materials will become property of Music Teachers Network llc. Camper names, ages and personal information will not be disclosed or published. Do you give permission for the publication of photos, videos and/or audio recordings of your child? YES NO (Parent/Guardian s Signature) Page 2 of 2
POLICES AND REGULATIONS CAMPER CODE OF CONDUCT Our Code of Conduct is not meant to keep you from having fun; when everyone works together and is respectful of each other and the equipment, we will all have a great time. 1. Campers will be careful and respectful of Camp equipment and facilities. 2. Campers are responsible for their own equipment and belongings. Camper should put their names on anything they bring to camp. 3. Being disrespectful of adults and/or staff will result in non refundable dismissal for the day. 4. No vulgar or obscene or curse words allowed, and no vulgar or obscene words, phrases, or symbols allowed on any article of clothing or any other article brought to Rock Camp. 5. Any type of verbal abuse, fighting, pushing, stealing (no finders keepers ), or use of other students or faculty members property without prior permission will result in dismissal. 6. Absolutely NO smoking, drugs or alcohol on campus. 7. Campers may not leave Rock Camp unless they are released to someone on the pre authorized list. The Camp Director must be notified by the parent/guardian if a camper is leaving early, going to be absent, or are being picked up by anyone other than the people on his/her authorized list this includes car pooling. 8. Campers will wear either a black or a grey T Shirt or Tank Top to camp each day. On the first day of camp, campers will be given an MTN Lanyard that must be worn AT ALL TIMES while on Camp premises. 9. Parents/Guardians agree, on behalf of themselves and their children, and their assigns, executors, and heirs, to indemnify, and hold harmless, Music Teachers Network llc, and its agents and employees from any and all liability, damage and claims of any nature arising out of or in any way related to their children's participation in this program except those things caused by the gross negligence of Music Teachers Network llc. 10. Parents/Guardians understand that a $150 deposit is due at time of registration. This deposit not refundable after May 31 st. Payment in full is due by June 30 th. Music Teachers Network llc reserves the right to expel a student with no refund for any behavior that is detrimental to the running of the Camp at their own discretion. (Parent/Guardian s Signature) (Camper Signature) Page 1 of 2