Summer Camp Enrollment Form

Your Child's Name (required)

Your Name (required)

Your Email (required)

Camp Session(s) (You can select multiple sessions.)
Session 1: May 21-25Session 2: May 29 - June 1Session 3: June 4-15Session 4: June 18-29Session 5: July 2-6Session 6: July 9-20Session 7: July 23 - August 3Session 8: August 6-10

Instrument(s) of choice:

guitarbassdrumspianovoice

What is your child's experience level on his/her instrument?
Beginner (0-2 years)Intermediate (3-5 years)Advanced (6 or more years)

Gender:
malefemale

Date of birth:

School attending:

Your Child's Grade in Fall 2017

Child's shirt size
Youth smallYouth mediumYouth largeAdult smallAdult mediumAdult large

Your home phone:

Your cell phone:

Your work phone:

Your Street Address

City

State

Zip Code

How did you hear about us?
---Word of MouthFacebookGoogleCraigslistYelpYellow PagesInternet SearchPrint Ad

Additional request

Promo Code:

I grant Dave Simon's Rock School permission to use either a photograph, video, or film image of my child for the promotion of Rock School. Promotional materials include Dave Simon's Rock School web site, brochure, poster, or news related mediums.
yesno