LA ROCKS SUMMER CAMP

June 9th - 20th Grades 4th-7th 9:00am-12pm
June 9th - 20th Grades 8th-12th 1:00pm-4:00pm

How old will the camper be at the time of camp?
If the camper's birthday falls during camp, please let us know the dates so we may celebrate!
What is the camper's instrument of choice?
If instrument is other, please specify.
Does camper play other instruments? Please list the other instrument the camper plays.
Has the camper taken lessons
What level do you consider the camper's playing skill (or singing skill if participating as a vocalist)? Please give us your best guess.

All parents/guardians of LA Rocks Summer Camp participants agree to the LA Rocks Summer Rock Camp policies. Please take a moment to read and understand each policy. You may contact us with any questions or clarifications at 505-946-7523 or matt@mattpratherguitar.com.

Please include full name of the Parent/Guardian as a digital signature indicating you have read, understand, and agree to LA Rocks Summer Rock Camp Policies.
Is there anything else we should know? (e.g., allergies, disorders, special accommodations needed, etc.)

Medical Authorization

Matt Prather Guitar will make every attempt to contact the parent/guardian/emergency contact(s) listed for my child in the event of an emergency. However; I understand that immediate action to obtain medical transportation and treatment of my child may be necessary. I authorize the emergency contact(s) listed to make medical decisions for my child. In the event contacts provided cannot be reached in a timely manner, I hereby authorize The Matt Prather Guitar employees / agents to obtain medial transport if necessary, and to authorize a licensed physician to administer treatment deemed necessary or advisable. I agree to pay all necessary costs of medical transport, treatment and hospitalization. I also waive, release, indemnify and hold harmless Matt Prather Guitar and its employees / agents / contractors, either jointly or separately from a loss, claim, costs or liability which may result from any and all acts associated with obtaining emergency medical treatment for my child.

Agreement

By enrolling a participant in The LA Rocks Camp, it is binding that this agreement is understandable and agreeable by the Signatory. A digital signature, included in this online registration, executes this agreement.

Please provide insurance information to include: Name of Insurance Company, Policy Number, Phone Number and Name of Policy Holder.
Please provide medical information to include: Medications to be taken during camp (name, type, dosage and reason for taking), allergies to medication, medical conditions we should be aware of (peanut allergies, diabetes, epilepsy, etc.) and anything else you think we should know including behavioral/emotional concerns or needs.
Please provide physician information to include doctor name, doctor phone, and doctor address.
Emergency contact names, phone numbers and relationship to camper.


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