Winds and Percussion Camp Registration Form
  • Limited Enrollment 
    Please note that although the deadline for registration is May 9, students are encouraged to register early. Because of the need to balance instrumentation for one or possibly two bands, registration may be closed for some instruments before the camp is full. 
    After you have filled out and submitted the payment form, and your payment has been accepted (indicating there is a spot available for your child's instrument), please complete this registration form and submit.  


    Registration and Medical Information 
    Please complete the registration no later than May 9. The fee is refundable (less a $30 administrative fee) if enrollment is cancelled by May 23, 2014.  For more information, contact James Swearingen at 614-236-6261 or by email at Information and maps will be sent the week of May 26, 2014. 
    First Name 
    Last Name
    Middle Initial

    Home Phone
    Emergency Phone #1 
    Emergency Phone #2 
    Parent's Email (for camp reminders, updates and materials) 

     Grade (Fall of 2014)

    Current Director's Name 
    School (current)
    School Address 


    Shirt Size (adult sizes) 

    Years of participation

     Important Medical Information 

    Name(s) of Parent(s) / Guardian(s)
    Name of Physician 
    Physician Phone

     Date of Last Tetanus Shot 

     If participant has a physical or other condition that may pose an undue risk to the participant or others in the program, please provide necessary information or special requirements (e.g., medications) or requested accommodations. 
     I hearby give permission for emergency medical treatment of the child named above by his/her own physician or a physician on-call. 

     I authorize my child to participate in all activities of the Capital University Winds and Percussion Camp, June 9-13, 2014. I understand he/she is expected to observe all camp rule and in case of failure to do so, I am responsible for immediate transportation home. I further understand and agree  that there will be no refund of camp fees in the event of my child's dismissal from any portion of the camp.

    By submitting this form, you agree that all information contained within is correct and that you are the legal guardian of the participant as stated in this form.