SAMZ SCHOOL SUMMER DAY CAMP
OFFICIAL REGISTRATION FORM
211 Monterey Street
Salinas, CA 93901
Email:
(831) 235-9588 or 235-9589
Student’s Name ______Age_____ School ______

Mailing Address ______City/State/Zip ______

Parent Email ______Cell Phone: ______
Please note: Confirmations, updates, etc. will be sent via email or text. Please provide an email address that is checked regularly. If you prefer to be contacted by text or phone only, please check box 
Any Special Dietary Needs or Medical Problems we should be aware of? ______
Please note students must bring sack lunch. Healthy snacks and bottled water will be provided at camp. If you can help contribute any snacks or bottled water please let us know.
Check box instruments your child can play. (Check all that apply, circle years of experience)

Guitar1 year1-2 years 3-4 years 5+ years  I will bring my guitar

Bass1 year1-2 years 3-4 years5+ years  I will bring my bass guitar

Drums1 year1-2 years 3-4 years5+ years (Please bring own drum sticks)

Piano1 year1-2 years 3-4 years5+ years

Vocals 1 year1-2 years 3-4 years5+years

Can your child read standard music notation? Yes  NoRead tabs? Yes  No
Interested in singing lead or back up vocals?  Yes  NoHas he/she ever played in a band?  Yes  No
How did you hear about Samz School of Music?  Flyer  Internet  Newspaper  Friend  Attended before.
Summer Camp Time: 9:00 a.m. to 4:00 p.m. M-F

Includes bagels and cream cheese breakfast and snack in the afternoon. Please provide sack lunch for your child. Lunch is at 12:30.

Tuition for one week session is $250.00 each student

Students must attend all camp days to be able to perform at Finale Concert.
Open to Students Ages 8 to 18 (Beginning to Advanced)
Checks payable to Samz School of Music, Inc. or use Pay Pal on our website: Samzschoolofmusic.com

Choose your Camp Session Week:
_____ Session 1 Starts Monday, June 12 to Friday, June 16th
_____ Session 2 Starts Monday, June 26 to Friday, June 30th

_____ Session 3 Starts Monday, July 17 to Friday, July 21st

Each Camp Session ends with a Finale Rock Concert

PARENTS: Please read the following Release and Consent clause and sign at the bottom of this form: (Parental signature is required for your child to participate in Samz School of Music, Inc. programs) . Permission for my child to participate in the Samz School of Music programs and/or Samz School of Rock Summer Camp is given with the agreement of the following terms: I hereby indemnify and hold harmless and release Samz School of Music, Inc. its agents and employees, for any and all liability for injury suffered by myself or my child arising from or connected with these programs, and I assume all risk for any injuries received. It is understood that Samz School of Music, Inc. provides no medical insurance for injuries and that the cost thereof will be at my expense. Samz School of Music is a substance-free organization. All students and staff members will refrain from any foul language, reckless behavior, smoking, alcohol consumption, or the taking of any illegal drugs, while participating in any session activities and while on the camp premises. Theft and vandalism of Samz School or the camp location school property or any property of others is prohibited. Any violation of these rules and policies will result in immediate dismissal from SamzSchool of Music. No refunds of any kind will be issued.

Parent/Guardian ______Cell # ______
Print Name and then Sign Please
Below is for Office Use
DATE Paid: ______Receipt # ______