I would like to sign up for: * Rock Week (June 9-13, 2025) Worship Week (June 23-27, 2025) Student Name * First Name Last Name Gender * T-Shirt Size * Please list any student food allergies or medical conditions Mullins Music should be aware of * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Birthday * MM DD YYYY Parent/Guardian #1 Name * First Name Last Name Parent/Guardian #1 Phone * (###) ### #### Parent/Guardian #1 Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Parent/Guardian #1 Email * Parent/Guardian #1 Relationship to Student * Parent/Guardian #2 Name First Name Last Name Parent/Guardian #2 Address Address 1 Address 2 City State/Province Zip/Postal Code Country Parent/Guardian #2 Phone (###) ### #### Parent/Guardian #2 Email Parent/Guardian #2 Relationship to Student Emergency Contact Name * First Name Last Name Emergency Contact Phone * (###) ### #### Please select your primary instrument. * Guitar Voice Bass Keyboard Drums Saxophone Trumpet I want to attend summer camp as an A/V tech If attending as an A/V tech, please submit a statement in the box below explaining why you want to attend summer camp and what you hope to learn by attending. Unless Mullins Music is given advance written notice to the contrary, students give consent for Mullins Music to take photos, audio or video footage of classes, lessons, ensembles and or/concerts without advance notice and to publish such photos, audio and video footage royalty-free in its print, audio and electronic promotional efforts, including its website. This consent also authorizes release from any expectation of confidentiality for minor children if a parent or legal guardian. In case of emergency, I understand that every effort will be made to contact me or the emergency contact listed above. In the event we cannot be reached, I hereby give my permission to the physician to give appropriate treatment to my child. I/We, the parents or legal guardians of the above-named camper, hereby give approval for his/her participation in any/all program activities, and do hereby waive, release, absolve, indemnify, and agree to hold harmless the organizers, supervisors, participants, and persons, involved in the operation of Mullins Music for any claim arising out of injury to the above-named camper, or any member of his/her family that may be participating as a spectator. * Parent/Guardian Digital Signature Required Below. First Name Last Name Date * MM DD YYYY Thank you for registering for a Mullins Music Summer Camp!Please don’t forget to submit your placement audition video via WeTransfer.You will be invoiced for camp after we receive your video and completed registration!
