Lake Winni Overnight Music Camp

2017 REGISTRATION FORM

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Full Tuition: $775.00 per week. Please complete one registration form per camper and return to Lake Winni
Music Camp with $200 deposit for each camp week. NOTE: Parent/guardian must complete and sign the
middle section of this form. Thanks!

Check which week(s) you would like to attend:

_____Week One: July 23-29, 2017 _____Week Two: August 6-12, 2017

Camper Name:__________________________________________________________________________
Camper Age:_____________________ Gender:_______________
Camper Instruments(s) & Number of years studied:______________________________________________

OPTIONAL: Learn a new instrument

While at camp, your child can learn a new instrument. They can choose: voice, piano, guitar, drums, bass, saxophone,
clarinet, flute, trombone, or violin. With the exception of piano, guitar, and drums, you must bring this instrument with
you. If you are interested in this option, please check here ____ and write in the name of the instrument your child
would like to learn here ____________________________.

This section must be completed by a parent/guardian (please print):

Name of Parent(s)/Guardian(s):_____________________________________________________________
Email:_________________________________________ Work phone:_____________________________
Home Address:_______________________________ City:________________ State:______ Zip:________
Home Phone:_____________________________ Mobile Phone:__________________________________
Summer Address:______________________________ City:________________ State:_______ Zip:_______
(if different from above)
Summer Phone: __________________________ Dates at Summer Address:__________________________
Emergency Contact Name:___________________________ Phone:________________________________
I hereby grant permission to Lake Winni Music Camp and the Geneva Point Campground to secure emergency treatment and/or routine
medical care as needed for the person named on this form while at camp. He/she may participate in all camp activities, including off-site field
trips, and photographs of same may be used for camp publicity.
Signature of parent/guardian:___________________________________________ Date:__________________

Camper Cabins and Camp T-shirts

I would like to be in a cabin with ________________________. Requests to bunk with a friend must be submitted in
writing by both campers at least two weeks prior to camp. Requests are granted as space allows.

Please select one size for your camp t-shirt:

_____Adult Small _____Adult Medium _____Adult Large _____Adult Extra Large

How did you hear about this camp?

__Newspaper __Direct Mail __Camp Fair __Alumnae Camper __Web/Internet __Friend
__Other:__________________________________________________________________(please explain)

Please mail registration by June 15, 2017 with $200 deposit for each week to:
Lake Winni Music Camp
ATTN: Noelle Beaudin
420 Holderness Road, Center Sandwich, NH 03227
Make checks payable to: Lake Winni Music Camp
The balance of tuition will be due when you receive a confirmation from Lake Winni Music Camp that your
registration has been accepted.