2017 Summer Music Camp Application

Name *

First Name

Last Name

Gender *

Male

Female

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

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Students must participate in one of the two class tracks provided, please select below. *

Piano

Voice

For the class track selected, please rate the student's level of experience as "B" or "I". *

B = Beginner with no experience; I = Intermediate with minimal training

B - Piano

B - Voice

I - Piano

I - Voice

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Name *

First Name

Last Name

Phone *

(###)

###

####

Is the student presently being treated for an injury or illness, or taking any form of medication for any reason? *

Yes

No

Is the student allergic to any food or medication? *

Yes

No

Does your student require a special diet? *

Yes

No

Does your student have any behavioral or emotional issues the staf should be aware of? *

Yes

No

Please indicate how you heard about Pure Sound Production, Inc.'s 2017 Music Camp.

Website

Facebook/Instagram

Word of Mouth

Flyer

School

Other