Knollcrest Music Camp Middle School Week Registration

Student Info

First Name

Last Name

Preferred Name

Gender

Birthdate

Grade Entering in the Fall

School Currently Attending

Home Address

Street

City

State

Zip Code

T-Shirt Size

Adult sizes only

Parent/Guardian Name

Parent/Guardian Phone

Parent/Guardian Email

Secondary Parent/Guardian Name

Secondary Parent/Guardian Phone

How did you hear about KMC?

Did you pre-register for KMC?

Pre-registrations included a non-refundable deposit of $25 and were collected in August 2023. Those who pre-registered have received a discount code for $50 off of their registration

Do you have a scholarship?

Scholarship granting entity

If you received a scholarship from a school or community organization, please list that organization(s).

Scholarship amount

If you received a scholarship, please list the amount(s).

Camp Permissions and Agreements

Camp Publicity Consent

I consent for use of student's image in publicity (photo and/or video).

Camp Attendance

I agree that my student will attend class full-time and will perform in the Friday evening concert.

Liability Waiver

Click here to read the document.

Medical and Emergency Information

Family Physician

Physician Phone Number

Insurance Company

Insurance Company Policy Number

Policy Holder

Medical Conditions

Please identify any significant medical conditions (i.e. asthma, diabetes, allergies/reactions to medications, foods, bee stings etc.), major illnesses, or injuries that may affect your child's participation in Calvin University activities.

Medications

Medical Release and Liability

I understand that Calvin University does not provide medical insurance for program participants. I hereby confirm that my child is covered by the health insurance policy listed above. I authorize Calvin University or its designated person to secure medical attention for my child if any such person deems necessary if I am not available to make a decision regarding such medical attention. This consent shall not impose any obligation to provide such medical attention and it is understood that such persons might not be trained medical personnel. I hereby authorize the Grand Rapids emergency health care system to provide any necessary care.

Emergency Contact Name

Emergency Contact Phone

Scheduling and Registration

Please visit the Knollcrest Music Camp site at https://www.calvin.edu/go/kmc for more information on ensembles and electives.

Primary Ensemble

Primary Instrument

Primary Instrument/Voice Part

Years of Experience Primary Part

Please choose between either a secondary ensemble or elective classes

I would like to sign up for a secondary ensemble (jazz band, musical theatre, etc.)I would like to sign up for electivesEach of these options will fill a student's schedule. Schedules cannot accommodate both a secondary ensemble and electives. Students must choose between the two. The secondary ensembles (jazz band and musical theatre) meet three times each day. Students who choose electives will submit 6 classes in order of preference and will be scheduled with 3 that will each meet once a day.

Electives

Please sign up for six electives in order of preference. KMC office staff will do their best to accommodate student preferences. Those who have pre-registered are scheduled first, and then all other registrations are scheduled in order of registration date.

First Preference

Second Preference

Third Preference

Fourth Preference

Fifth Preference

Sixth Preference

Chamber Music Instrument

Because you have selected Chamber Music as an elective of interest, please select the instrument you are interested in playing.

Chamber Music Instrument Years of Experience

Number of years of experience you have on the instrument selected above.

Voice Elective Voice Part

Because you have selected Voice as an elective, please choose a voice part.

Voice Part Years of Experience

Number of years of experience you have with the voice part selected above.

Brass Instrument

Because you have selected Brass Techniques as an elective of interest, please select the instrument you are interested in playing.

Brass Instrument Years of Experience

Number of years of experience you have with the voice part selected above.

String Instrument

Because you have selected String Techniques as an elective of interest, please select the instrument you are interested in playing.

String Instrument Years of Experience

Number of years of experience you have on the instrument selected above.

Payment Agreement

Use the link on the following screen to complete your payment and registration. Once you click the payment link, please scroll down and select "summer camps."

Registrations are considered complete once payment has been received.

Once payment has been received, should you need to cancel your student's registration, Knollcrest Music Camp will retain $12 to cover the cost of fees.

If you will be paying offline with a check, please mail your payment as soon as possible to 1795 Knollcrest Circle SE Grand Rapids, MI 49546 attn: Knollcrest Music Camp