2019 Hip Hop Orchestra Summer Music Camp Registration

Hip Hop Orchestra Summer Music Camp Registration

July 22-27, 2019. East Liberty Presbyterian Church, 116 S. Highland Ave, Pittsburgh, PA 15206. Registrations will be accepted until July 15, 2019
Camp Participant's Information
Camp Participant Name: *

First Name Last Name
Nickname/Preferred Name:
Birth Date: *

Month Day Year
Age
Preferred Gender Identity *
Race & Ethnicity *
Home Phone Number: *

Area Code Phone Number
Mobile Number (if applicable):

Area Code Phone Number
Email Address (if applicable):

Primary Address: *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Please provide any medical or dietary restrictions the camp participant has:
How did you hear about Camp?:
School Information
School child attends *
Grade Entering Fall 2019: *
Instrument
Other Instrument(s) *
Do you own or have access to the instrument your child will play at camp? *

Yes No, we will borrow an instrument from Hip Hop Orchestra Summer Music Camp for the duration of camp (see next section)
Instrument Loan Agreement

I understand that if needed, my child will be borrowing an instrument from the Hip Hop Summer Orchestra Camp for using during the week of camp (July 22-27, 2019), and I agree to: 1. Return the instrument in good condition after the final concert, or if the student discontinues camp for any reason. 2. Pay for any damage caused to the instrument or its case due to neglect, lack of proper care/maintenance, or mistreatment. 3. Notify Camp Staff if you are in need of any extra cleaning supplies or accessories (such as strings, picks, capos, rosin, cleaning swabs, cleaning sticks, etc). 4. Notify Camp Staff immediately of any problems with the instrument. 5. Replace any lost or stolen instrument.
Family Information
Parent/Guardian's Name: *

First Name Last Name
Parent/Guardian's Name
First Name/Last Name
Contact Phone Number: *

Area Code Phone Number
E-mail Address: *
Emergency Contact Information
Emergency Contact Name: *

First Name Last Name
Emergency Contact Phone Number: *

Area Code Phone Number
Relationship to Student: *
Scholarship Applicants are required to pay the $10.00 Camp Registration fee. You may pay this fee by the following two option:

1) Pay Online by clicking "Camp Registration Fee"

2) Mail-In Payment by clicking "Pay by Mail" (no fee required to submit form).
Camp Registration

Camp Tuition (Including Registration Fee) $ 160.00

Camp Registration Fee $ 10.00

Pay by Mail (registration fee and/or camp tuition) Free

Student Internship Free
Through a special grant, scholarships are available to black youth with priority given to early applicants. Scholarship Applicants must provide a handwritten letter (written by the camp participant) saying why they would like to attend the Hip Hop Summer Orchestra Music Camp and why it will help them grow on their instrument. This can be as lengthy and detailed as is age appropriate. You can upload the letter below or take a picture of the letter and upload a jpeg or pdf and email to hiphoporchpgh@gmail.com

In the subject of the email please provide the child's name, age, and instrument and the words "Scholarship Letter"

Scholarship Applications will be accepted until July 15, 2019
Upload Scholarship Letter Here

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By submitting this form you agree to the Instrument Loan conditions above, as well as for complete and timely payment of the camp tuition.

Don't have paypal? Please head over to Camp Website Payment Page, where you can also print, complete, and mail in this form and payment to PO Box 8164, Pittsburgh, PA 15217. Make checks payable to Guardian of Sound.
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Hip Hop Orchestra Summer Music Camp Registration

School Information

Instrument Loan Agreement

Family Information

Emergency Contact Information