*Student Name

Parent Name
(if under 18 years old)

*Email

Birth Date
(xx/xx/xxxx)

Phone

Secondary Phone

Address

City

State - NC SC

Zip Code

Instrument - bass drums guitar piano/keyboard vocals other

Camp Please select a camp here... July 12-16 Kreative Kids Idol $125 July 26-30 Drums $150 August 9-13 Kreative Kids Idol $125

Message

Medical Information
(allergies, etc.)

Physician

Physician Phone

Emergency Contact

Referred By

Form Name Summer Camp Registration

*Required Fields