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2011 SUMMER JAZZ CAMP

JAZZ ORCHESTRA ATLANTA
PO Box 190106, Atlanta, GA 31119
Telephone: 770-992-2559 E-Mail: info@jazzorchestraatlanta.org

REGISTRATION FORM
(Use a separate form for each participant. Please complete all information)
One year of previous jazz band or private lessons is recommended.

Which camp you are registering for? SUMMER JAZZ CAMP
Student Name:
Address: *
City: *
State: *
ZIP: *
E-mail Address: *
Age Today:
Date of Birth:
Entering Grade:
Instrument:
Instrument Needed:
Other Training:
CONTACT INFORMATION:
Name of Parent/Guardian:
Home Phone: *
Work Phone: *
Cell Phone: *
EMERGENCY CONTACT:
Name of Emergency Contact: *
Relationship:
Phone: *
PERSON AUTHORIZED TO PICK UP STUDENT:
Name of the person authorized to pick up student: *
Relationship:
Phone: *
* Required  
WAIVER OF LIABILITY: I assume all risk associated with this activity, including but not limited to falls, contact with other participants or equipment, effects of weather, equipment failure and condition of camp facility. I fully understand that it is my responsibility to ascertain if this specific activity contains other elements of risk that could prove to be harmful to a participant. Having read this waiver and in consideration of acceptance of entry into the program, I and anyone entitled to act on my behalf waive and release Jazz Orchestra Atlanta, its co-sponsors, their representatives and successors from all claims and liabilities of any kind arising out of my child's participation in this activity.

By submitting the form you are agreeing to the above waiver of liability.
 
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