Overnightmusic Camp for Girls

OvernightMusic Camp for Girls

Wednesday and Thursday, July 11-12, 2018

REGISTRATION FORM Please PRINT everything

Camper’s Last Name ______First ______

Camper’s Mailing address ______

Town, State, ZIP ______

Primary phone number to contact legal guardian/parent ______

Other mom/dad numbers (cell, home, work)

Who? ______Relationship? ______PH: ______

Who? ______Relationship? ______PH: ______

Other phone numbers you want us to have (grandma, neighbor?)

Who? ______Relationship? ______PH: ______

Who? ______Relationship? ______PH: ______

PRINT email address where we can send information as camp gets closer ______

Daughter’s Pediatrician name ______Phone ______

Please initial these items, denoting consent, or write in “NO”

_____ I am giving Darla Bair permission to obtain emergency medical care from an ambulance or hospital staff if deemed necessary.

_____ I understand my daughter will not have use of her cell phone during camp activities. The camp staff believes it is important for all campers to be fully present in the activities and not texting or calling friends. Should you need to contact your daughter, please use the camp number 585.494.1795. If there is any reason for her to contact you, she will have access to our phones.
_____ I give permission for my daughter’s image to be used in photos or videos for promotion of the Amadeus Chorale. Her name will never be included.

What do you want the camp staff to know about your daughter to assure she has an optimum experience at camp?

Behavior ______

Medical ______

Social ______

What is your daughter allergic to? Food?Animals?Hay?Beestings?Grass? ______

Does your daughter require medication to be given during camp? ______

If yes, please give details and be prepared to give the medication to a staff member upon arrival. ______

Does your daughter carry an epi-pen? ______If yes, for what reason? ______

Please tell us about dietary restrictions for your daughter. Include food allergies, vegetarian or other specialty diet, gluten-free, lactose-intolerant, and others. ______

Please keep reading ...

Things to know:

1. Campers should arrive between 8:00 and 8:15 am on the first day.

1. Camp is held at Calm in the Chaos Interfaith Center, 6590 Lake Road S, Brockport, NY.

1. Darla Bair, the Founder of the Amadeus Chorale is the Camp Director. She has extensive experience in resident girls’ YWCA, Campfire Girls and Girl Scout camps.

1. Your daughter should bring a sleeping bag, personal items, jammies and clothing for both days. Please make sure she has a sweatshirt and long pants for the campfire.

1. Campers should eat breakfast before arriving. Meals provided: first day lunch and dinner, second day breakfast and lunch.

1. All materials for music activities and crafts are included in the camp fee.

1. If your daughter takes medication, please put it into a Ziploc baggie and make certain that clear directions are included.

1. There are animals on the property – cat, dog, chickens and sheep. If your daughter is allergic to these animals, please alert us upon arrival.

Parent/guardian signature ______Date ______

Please complete this entire form and enclose a check for $90.00 payable to Darla Bair

Mail to 6590 Lake Road, Brockport, NY 14420

Questions? Please email or call 585.494.1795