Youth Music Outreach
Summer Music Camp 2011		 Please complete and return with your non-refundable $100 registration fee to:
Youth Music Outreach
PO Box 300008
Escondido, CA 92030

Student Name:
*

Parent’s Name:
*

Address:
*

City, State Zip:
*

Home Phone:
*

Cell Phone:


E-mail Address:
(parent)
*

How did you hear about the YMO 2011 Summer Music Camp?

 Band Director
School
Private Instructor
YMO Website
Other Website
Magazine Ad
Music Store
Friend
Other

Birthdate:
*

Gender:   Male    Female

Primary Instrument:

Years Played:

Secondary Instrument(s):
(if applicable)


Years Played:

Private Instructor’s Name:
(if applicable)

Band Director’s Name:
(if applicable)

Church:
(if applicable)

School:

T-shirt Size:
  AS
  AM
  AL
  AXL

E-mail Address:
(student)

Please note any medical conditions or allergies (especially to food):
(All students will be given a medical release form in registration packet.)


If accepted into the YMO 2011 Summer Camp,I agree to participate in all events and activities.
I further agree to abide by all rules and regulations.

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