Text Box: St. Andrew Summer Music Camp 2010 Registration Form About the Camp Classes will be July 19-23, 2010 from 9:30am-12:30pm. Parents and friends are invited to the guest performances on Tuesday and Thursday from 12pm-12:30pm. A final Celebration Potluck and Concert Performance will be held on Sunday, July 25 at 11:30am. Enrollment Cost Please print and send this completed form with $45 per child / $55 per family to St. Andrew Church, 9850 Monroe Ave, Aptos, CA 95003. For more information call us at (831) 688-4211 or email kathy@standrew-aptos.org. Youth’s Name________________________________________ Grade (2010-11 school-year) ________School _____________________________ Age______ Street Address_______________________________________ City_________________________ Zip_____________ E-mail___________________________ Parent(s) Name(s)__________________________________________________________ Day Phone #_____________________________________ Emergency Contact_________________________________________________________ Phone #________________________________________ Please list medications and/or food allergies : ___________________________________________________________________________________ In case of medical emergency, the Summer Music Camp at St. Andrew personnel are authorized to take my child to the hospital for emergency care including x-rays and surgery. I will not hold the St. Andrew Presbyterian Church or its agents liable. Physician ____________________________________________________________________ Phone #________________________________ Insurance Carrier ______________________________________________________________ Policy # _______________________________ Parent’s Signature _____________________________________________________________ Date __________________________________

St. Andrew Presbyterian Church, 9850 Monroe Avenue, Aptos, CA 95003

Phone: 831-688-4211, Fax: 831-685-2078, Email: kathy@standrew-aptos.org
Text Box: Where did you hear about us? LibraryWebsite Newspaper  Attended Summer 2009 Other