ONLINE FORM
William Carey  My First String Camp
June 5th-9th, 2017

Application deadline is May 26th 2017
This form has to be completed on-line and in upper case.
Student
Name:
Age on June
5th 2017:
Instrument:
T-shirt size:
School
Attended:
Grade:
Years playing instrument: 0, 1, 2, 3, 4, 5, 6:
Parent  or  Guardian:
This person will be responsible for all financial matters
Mailing Address:
City:
Zip:
State:
Phones: Home, Work, Cell:
E-mail:
9:00am to 12:00pm $160 (T-Shirt included)
50% ($80) Scholarship for HPSD Students
Instrument Rental Fee: $10.  Limited availability
Checks must be payable to Winters School of Music

Checks must be sent to: Winters School of Music  
498 Tuscan Avenue  Box 14  -  Hattiesburg MS 39401
Check Amount:
Check # / Bank
Date:
For additional information, please contact Daniela Pardo: (414)737-4620
WAIVER AND POLICY STATEMENT
has my permission to participate in lessons and classes through the William Carey My First String
Camp at the Winter School of Music on the campus of William Carey University.

I understand that they are risks, and that my child participate in this program at my/his own risk, and
that William Carey University will not be responsible for any personal injuries, property damage, or
related expenses, including but not limited to medical expenses, incurred as a result of my or my
child's participation in this class.

I understand and accept the policies of the William Carey My First String Camp as stated in the
accompanying pages, and accept responsability for charges and fees incurred.

I will allow the William Carey My First String Camp to use photographs,video and recordings
made at WCU or at String Camp functions, involving the student hereby enrolled.

STUDENT'S SIGNATURE or PARENT / GUARDIAN SIGNATURE,
if student is under 18 years old.  
If this form is sent by internet, it needs to be signed later in WCU's office.
Name:
Questions, comments, or feedback: