ABOUT THE PARTICIPANT

Name: __________________________________________________________ Date of

Birth: _______
Preferred Name (if different): _________________________________________________
Mailing Address:
_________________________________________________________________________
__
City: ______________________________ State: _______________________ Zip Code:
________________
Home Phone: ______ - ______ - _______ Cell Phone: _____ - _____ - ________
Email address you check frequently: _____________________________________
Best way to contact you? (circle one)

Home Phone

Cell Phone

Email

Do you have any medical conditions, allergies or dietary restrictions that Camp staff should
know about?
_________________________________________________________________________
__________
1

EMERGENCY CONTACTS

First Contacts Name: _________________________ Relationship: ___________

Home phone: _____ - ______ - ______
______

Work/cell phone: _____ -______ - ______ ext

Second Contacts Name: ______________________ Relationship: ___________

Home phone: _____ - ______ - _______ Work/cell phone: _____ -______ - ______ ext
______

WHAT DO YOU WANT TO PLAY?

Please put a 1 by your first choice, and a 2 by your second choice.
____Bass

____Drums

____Guitar

____Keyboards

____Vocals

HOW DID YOU HEAR ABOUT US:

Friend
Camper

Word of mouth

Our Website

Flier/Brochure

Returning LRC

Another website: _________________________

Saw an ad:_____________________________

Other__________________________________

Please write a brief paragraph that helps us get to know you. Tell us about your musical
experience and why you want to rock with us!

INCLUDE THIS PAGE IN YOUR APPLICATION