Gem State Jazz Camp

Gem State Jazz Camp Registration Form

* Indicates required field

Parent/Guardian Name *

First

Last

Parent/Guardian Email *

Parent/Guardian Phone *

Mailing Address *

Line 1

Line 2

City

State

Zip Code

Country

Note: In case of emergency, the parent/guardian will be contacted first. Please provide an additional contact in the event the parent/guardian is not reachable.

Emergency Contact Info: *

First

Last

Emergency Phone *

Emergency Email *

Which camp are you interested in joining? *

Middle School (entering grades 7-9) High School (9-12th Grades) Both! (entering 9th Grade)

The Middle School camp is for students entering 7th through 9th grades.
The High School camp is for students entering 9th through 12th grades.

Students entering 9th grade can join both camps for 10% off the total package!

Student Profile Information

Let us know about our incoming student - Please fill out a new form for each student if you have multiple joining us.

Student Name *

First

Last

Instrument *

Years Studied *

Taken Private Lessons? *

Yes No

Private Teacher Name *

First

Last

Secondary Instrument *

Years Studied *

Current School Name *

Current Band/Orchestra Teacher *

First

Last

Entering which grade, this coming fall? *

Camp T-Shirt Size *

Gender *

Male Female

Please list -all- food allergies or restrictions, and any other important physical or mental health information *

Required - Camp photos & videos will be used in promotional and marketing materials for Gem State Jazz Camp and Exodus Music LLC *

I agree and understand there will be a media and liability release form required to participate in the camp

Media and Liability Release Form (opens in new window)

I agree to receiving marketing and promotional materials *

Submit

2022 Registration

Gem State Jazz Camp Registration Form

Student Profile Information

Services

Company

Support