Music Camper Registration & Health History

Camper Personal Information

Date of Birth*(Required)

Parent Contact Information

Non-Parent Emergency Contact

Insurance Information

Parents and guardians are responsible for medical expenses incurred for illness or injury at Choir Camp. Insurance Co/Medicaid:
Policyholder's Date of Birth:

Allergies & Illness

Date of Last Reaction:
Date of Last Reaction:
Has a psychiatric diagnosis such as Depression, OCD, and Panic/Anxiety Disorder.
Has seen or is seeing a professional to address mental/emotional needs.
This camper has a learning disability/challenge.
Has camper ever required any psychiatric counseling or hospitalization?


Please list medications that will be given to camp nurse on check-in, including drug, dosage and condition requiring the medication. Prescribed medication and inhalers MUST be in original container with pharmacy label that includes camper’s name, valid date, instructions and Dr’s name. Sample medications MUST have signed physician’s letter. Over-the-counter medications MUST be in original packaging with valid expiration date.

Camper Information

Previous Music Camp experience?
Other Previous Camp experience?
Does camper have siblings?
No previous musical or choral experience is required for attendance.
Are both parents living?

Please rate your camper in the following areas:
4 = Excellent
3 = Good
2 = Needs Improvement
1 = No experience

Roomate Preference

Roommate requests will be honored as much as possible, but no requests are guaranteed. Rooms are double-occupancy, two room suites with showers.
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