REGISTRATION

Please complete the fom below for registration. All fields marked with an (*) are required.

Camp Registration

Student First Name *

Student Last Name *

Street Address *

City *

Zip Code *

State (Home) *

County/Parish *

Parent/Primary Email
used for all communications *

Parent/Primary Phone
used for all communications *

Student Mobile

Student Age (Must be 10 years or older) *

Current School *

Grade *

School City *

School State *

Are you currently studying music in school? *

Yes No

If no, how are you receiving instruction?

Primary Instrument *

Number of Years *

Name of Instructor(s)

T-Shirt Size

How did you hear about camp?

Campaign

Parent Information

Parent First Name *

Parent Last Name *

Parent Address *

Parent City *

Parent State *

Parent Zip Code *

Parent Email *

Parent Phone *

Parent Mobile

If student is staying with a family member or friend please provide the info below.

Family/Friend First Name

Family/Friend Last Name

Family/Friend Email

Family/Friend Cell Phone

Family/Friend Address

Family/Friend City

Family/Friend State

Family/Friend Zip Code

2023 Louis “Satchmo” Armstrong Summer Jazz Camp