Registration Info

First & last name of camper:*

Name of parent(s)/legal guardian(s):*

Age of camper (at time of camp):*

Street address:*

City, State & Zip:*

Home phone:

Work phone:

Cell phone:

Email address:*

Emergency contact name:*

Emergency contact phone:*

1st instrument choice (pick ONE only):*
Bass
Drums
Electric Guitar
Keyboard
Vocals (band)/Bass (instrument class)
Vocals (band)/Drums (instrument class)
Vocals (band)/Guitar (instrument class)
Vocals (band)/Keyboard (instrument class)

2nd instrument choice (pick ONE only):*
Bass
Drums
Electric Guitar
Keyboard
Vocals (band)/Bass (instrument class)
Vocals (band)/Drums (instrument class)
Vocals (band)/Guitar (instrument class)
Vocals (band)/Keyboard (instrument class)

If signing up for guitar or bass, will you need to borrow one of our instruments:
yes
no

Camp week:*
7/16/12
7/23/12

Camper T-shirt Size:*
Large
Medium
Small
Xlarge

Payment Method:
Check (must be received w/in 3 business days of registration)
Paypal (pay below)

If paying by Paypal, your Paypal user ID and address (so we can match registration w/payment):

Please describe camper's musical experience in the past (if any):*

Health Considerations: Has child had all necessary vaccinations:*
yes
no

List any medical conditions, allergies, behavioral or emotional issues the camper may have:

Is the camper on any medication to treat these conditions? If so, please list:

If medication needs to be administered during our program, are you giving us permission:
yes
no

If this is your first time at GRRR, how did you hear about us:

I have read and understand the "Camp Details and FAQs" page:*
yes
no

I HAVE VOLUNTARILY READ THE LIABILITY WAIVER AND RELEASE. I AGREE TO ITS TERMS AND CONDITIONS:*
yes
no

Please type the text below: