Summer Program Registration Form - Maestro Musicians Academy of Lexington

Camper/Junior Counselor Name *

First

Last

Camper/Junior Counselor Date of Birth *

Camper/Junior Counselor Name #2 (If applicable)

First

Last

Camper/Junior Counselor #2 Date of Birth (if applicable)

Parent/Guardian #1 Name *

First

Last

Parent/Guardian #2 Name

First

Last

Camper/Junior Counselor Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

Cellphone Numer of Parent #1 *

Cellphone Numer of Parent #2

Travel location(s) and telephone number(s) of camper's or staff member's parent(s) or guardian(s) if the parent(s) or guardian(s) will be traveling during our program

Name of Individual Picking Up Camper/Junior Counselor (If applicable) (Please attach a copy of ID below to lessons@maestromusicians.com)

First

Last

Second Name of Individual Picking Up Camper/Junior Counselor (If Applicable) (Please attach a copy of ID)

First

Last

Food allergies? If yes, please describe below: *

Name, address, and telephone numbers of camper's or staff member's family health care provider or health maintenance organization, if any *

Any medical issues that we need to know about? If yes, please describe below. *

Authorization for Emergency Medical Care *

I authorize Maestro Musicians to grant emergency care to my child in the event of a health emergency.

I give Maestro Musicians permission to administer prescription medication to my child if the camper or junior staff member brings a prescribed medication from home *

Yes

Please Read Carefully and Check Off *

Students and Staff must not come to camp if they have a fever, chills, diarrhea, vomiting, or persistent cough. There are no refunds during or after the camp session for students who are unable to come due to illness. I understand that in order to be fair to our staff, tuition is never prorated for missed days. In case of cancellation, tuition is 50% refundable up until April 1. After April 1, we will refund 50% of the tuition if we can find a camper to replace your child's spot. The ability to issue the refund is at the discretion of Maestro Musicians.

Copy of Updated Immunization Certificate(s) *

Click or drag a file to this area to upload.

Copy of ID(s) of parent(s) or guardian(s) doing pickup *

Click or drag a file to this area to upload.