Music and Drama Camp Registration By Maranatha | December 14, 2016 Step 1 of 5 20% Camper's Name* First Last Parent's Name* First Last Parent's Email* Parent's Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Will you be staying on campus in the dorms?*YesNoPlease note: Campers must have turned 12 years old by the January before camp in order to stay in the dorms. Otherwise, they can come at breakfast and leave after the evening service. Request another camper for a roommate First Last Please indicate if you are staying on campus ($15 fee per night) Sunday night Friday night Gender*MaleFemaleCamper's age during camp*Please check if NOT age 12 as of January 1, 2018(Note: underage campers may not stay in dorms or participate in evening activities unless their parents come to watch.) Camper is NOT 12 as of January 1, 2018 Camper's grade next fall*Choose One56789101112GraduateOtherName of school*Expected graduation year*Badger Bus, MKE to Johnson Creek (Transportation provided to and from Johnson Creek) Need Pickup at Johnson Creek Need Dropoff at Johnson Creek Track*BandPianoStringsStage CrewMusical/DramaVideo TrackPlease note the Stage Track is full and the Musical/Drama track has limited openings. Please write email@example.com to be placed on the waiting list. Musical/Drama Track Campers: Most campers will participate in the musical. If you would like to be considered for the advanced stage comedy track, please check the box below. By checking this box, I am indicating I want to be considered for the stage comedy. I realize that if I am in the stage comedy, I will not be in the musical. Music Campers: Choose One "Set A Elective"*Beginning and Cadet Band. Restrictions: Beginning Band Campers must choose this elective.Percussion Ensemble. Restrictions: 8th grade and up.Flute Choir. Restrictions: 8th grade and up.Chamber Groups. Restrictions: Only for intermediate to advanced-level musicians in 8th grade and up. Campers must be registered by May 1 to be in a Chamber Group.Beginning Hand Chimes. Restrictions: 8th grade and younger. No prior experience with chimes or hand bells necessary.Beginning Piano. Restrictions: 8th grade and younger.Golden Rules of Practicing. Restrictions: None.Music Game Time. Restrictions: NoneVocal Techniques. Restrictions: NonePractice Time. Restrictions: Option is only available for Piano and String Campers and can only be selected for one of the elective slots.For descriptions, see the Track Page.Music Campers: Choose One "Set B Elective"*Beginning and Cadet Band: The Beginning Band Director has special activities planned for the Beginning and Cadet Band members during this time. Restrictions: Beginning Band Campers must choose this elective.Intermediate Hand Chimes. Restrictions: 8th grade and up. Must be fluent in reading notes and rhythm. No prior experience with chimes or hand bells necessarySong Writing. Restrictions: 8th grade and up.Make Music—Make Money. Restrictions: 8th grade and up.Masterclass—Performance Critique. Restrictions: 8th grade and up.Beginning Percussion. Restrictions: 8th grade and younger.Bucket Drumming. Restrictions: 8th grade and younger.Golden Rules of Practicing. Restrictions: None.Music Game Time. Restrictions: NoneSinging Rounds. Restrictions: None.Practice Time. Restrictions: Option is only available for Piano and String Campers and can only be selected for one of the elective slots.For descriptions, see the Track Page.Music Campers: Indicate which instrument you will be playing at camp*Choose OneI'm in Drama, Stage-crew, or Video TrackFluteOboeClarinetBass ClarinetBassoonAlto SaxophoneTenor SaxophoneBaritone SaxophoneCornet/TrumpetHorn in FTromboneEuphonium B.C.Euphonium T.C.TubaPercussionViolinViolaCelloString BassPianoOtherBand Campers: Choose the appropriate band for your age and experience*Choose OneBeginning Band (no band experience)Cadet Band (one year of band experience-typically 6th or 7th Grade)Intermediate Band (two or more years of band experience-typically Junior High)Advanced Band (three or more years of band experience-typically Senior High)Music Campers Only: Years of experience and years of lessonsMusic Campers: Voice Part for ChoirSopranoAltoTenorBassT-Shirt Size (adult sizes) This year everyone will be getting a free shirt!*Choose OneSmallMediumLargeExtra Large1X2X Medical RemindersAll campers must have insurance documentation and tetanus and MMR vaccination records to participate in camp. All prescription medications must be given to the camp Health Supervisor in their original containers with instructions for dosage and times for administration upon check-in. We recommend that your child have a physical sometime within 12 months before attending camp.Medical ReleaseYou must complete a medical release to be registered for camp."I, (parent's name)...* First Last "...declare that I am the...*Choose OneMotherFatherGuardian"of (camper's name)...* First Last I hereby authorize the Camp Health Supervisor to dispense over-the-counter medications as per standard medical practice. In case of medical emergency when I cannot be reached by telephone, I hereby authorize the staff of the Maranatha Camps to secure appropriate medical treatment such as X-ray examination, anesthetic, injection, medical or surgical diagnosis or treatment, and hospital care necessitated by injury or illness, while the above-named child is attending a Maranatha camp. I agree to the release of any records necessary for referral, treatment, billing, or insurance. Services are to be rendered to the camper by legally qualified personnel. I hereby affirm that my child has no physical conditions that will limit participation in the full range of activities being planned, except as listed below. I hereby waive and release Maranatha from any and all liability.Parent/Guardian indicates agreement with above statement electronically by typing their full name here*Health informationPhysical*Yes, my child has had a physical in the last 12 monthsNo, my child has not had a physical in the last 12 months; I understand that a physical is recommended and take full responsibility for my child's health conditionIf yes, please enter where your child's physical is on fileCamper's physician* First Last Physician's Phone*Insured's Name* First Last Insurance Company*Policy Number*Insurance PhoneDate of tetanus shot*Date of MMR injections*AllergiesCurrent medicationsBriefly describe pre-existing injuries, other special medical conditions, or activities to be restrictedWhom should we contact in case of an emergency?* First Last Emergency Contact Phone # - cell phone is preferred*Does your child have any special needs/disability that would require special accommodations?*yesnoPlease explain. Note: We will review the information provided in light of staff availability and campus capacity and contact you for further information and/or to confirm our ability and proposed strategy to meet your child’s needs. Parents are responsible to provide special equipment and/or personal assistance needed to accommodate transportation and basic living arrangements. Payment information:Camp Tuition: $250. After April 10: $320. Beginning Band Day Camp: $80. Registration Closes June 15.Select your camp tuition rate based on your registration date:*$250 (registering by April 10)$320 (registering after April 10)$80 (Beginning Band Day Camp - 9:30AM to 4PM and includes lunch)If you are receiving a scholarship or special discount (other than the Early Bird discounts), please list the source and amount.Please Note:Registrations will not be processed until the $35 registration fee is paid. The registration fee is applied towards the overall tuition cost.Image Release. (If you have an extenuating circumstance requiring an exception, please e-mail Katie.firstname.lastname@example.org).*I give my permission to use photo and video images of the camper in MBU publications.Submit PaymentYou will be automatically directed to the payment page when you click submitHow did you first learn about Music and Drama Camp?*Camp PostcardWord of MouthFacebookEmailMBU WebsiteOther This iframe contains the logic required to handle Ajax powered Gravity Forms.