Grace Notes
Summer Strings Camp
Registration

Student Information

Student's First name

Student's Last name

School Enrolled for the 2025-26 school year:

Student's Grade Level for the 2025-26 school year

Student’s Date of Birth

Month

Day

Year

Instrument

Name of current music teacher:

Allergies: (Please list all allergies to drugs, foods, bees or other)

Medications: (Please list all current medications)

Parent/Gaurdian Contact

Full Name of Parent or Legal Guardian:

Street Address

City, State, Zip

Home Phone

Cell Phone

Program Sessions

Please Select a Program - Check only ONE BOX OR APPLY FOR FINANCIAL AID below. (Limited number of financial or need-based scholarships available.)

Option 1 (recomended)

Full session (June 15 - July 10)$1,250

Option 2

1st session (June 15 - June 26)$750

Option 3

2nd session (July 29 - July 10)$750

Option 4 (only if necessary for the student's schedule)

1 week (Please specify dates below)$500

Chosen Dates for One Week:

Financial Aid

Financial Aid - (Limited number of financial or need-based scholarships available.)

Apply for a partial scholarship

Signature

I herby authorize Grace Notes Music Foundation to use photographs, videos and statements of the student as needed in news releases, on the website, YouTube, social media and in other publicity materials.

Parent/Legal Guardian Initials

I understand that every effort will be made to provide a safe and supportive environment for all campers. However, I acknowledge that some risks may still exist. I voluntarily accept these risks and agree to release and hold harmless Grace Notes Music Foundation, its staff, volunteers, and affiliates from any and all liability for injury, loss, or damage that may occur during camp activities.

Parent/Legal Guardian Initials

Signature (Required) - Type Parent/Legal Guardian's Full Name

By typing your name above, you are electronically signing this document.

Questions about Grace Notes
Summer String Camp?
Email: info@GraceNotesMusicFoundation.org
Or Call Mr. Goering: (785)312-2604