Register by fax: 1-716-852-0687

Register by phone: 1-716-882-1876

Register by Mail  click here

Musical Background Form (Please Fill Out)

 

Room & Board

Breakfast, Lunch & Dinner (Buffets Daily)

Youth Music Camp Packets

Hours of Intense Music Classes & Seminars

Nightly Worship Explosion Services

Morning Prayer & Worship

Recreation

Worship CD Recording

Christian Fellowship

Late Night Bombfire & Snacks

Spiritual Music Mentorship
 

 

Click the image to view pictures from 2006

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


 

Register Online For Music Camp 2008

 

01 Camper's General Information
First Name:  
Last Name:  
Address:  
City:  
State:  
Zip code:  
DOB:  
Age:  
Gender:  
Parent 1 First Name:  
Parent 1 Last Name:  
Parent 2 First Name:  
Parent 2 Last Name:  
Home Phone:  
Work Phone:  
Cell Phone:  
E-mail:  
Church Name:  
Church Address:  
What instrument do you play?   
 
02 Camper's Emergency Information  
Emergency Contact  
Day Phone:  
Night Phone:  
Alt Phone:  
Relationship:  
Name of Doctor:  
Doctor's Phone:  
Do you carry family medical insurance?      yes      no
Carrier Name:  
Carrier Phone:  
Group Policy Number:  
Name of Insured:  
 

03 Medical Information

Give approximate dates of occurrences. Whether mild or severe full disclosure must be made for activities.
Medication Allergies (mark all that apply)     

  Penicillin     Amoxicillin     Sulfa     Ceclor

 

Other Medication Allergies: Please tell us about any other medications that the registrant may be allergic to.

 
Immunization    
Last Tetanus:  
Chicken pox:  
Measles:  
German Measles:  
MMR:  
Hepatitis:  
 
Allergies (select all that apply)    

  Asthma     Red dye    Lactose   

     

Other Allergies: Please tell us about any other allergies that the registrant may have.

 

Limitations: Please tell us about any limitations that the registrant may have.

 

Physical

 

Psychiatric

 

Mediations: Please tell us about any mediations that the registrant may use.

 

Prescription

 

Reason for taking

 
Disease (select all that apply)    

  Heart     Convulsions    Diabetes     Bleeding disorder 

     

Other Disease: Please tell us about any other diseases that the registrant may have.

 

Restrictions: Please tell us about any restrictions that the registrant may have.

 

Form of payment

Mailing in payment: Please make payment payable to:

 

Salter's Christian Music

953 Jefferson Ave

Buffalo, NY 14204

 

Paying by credit/debit card

PLEASE NOTE: If paying by credit card after submitting your form please continue to the online store to make your payment and complete your order.

 

***SPACE IS LIMITED****
Single Registration $700.00 per                       Qty:

Group Registration (10 or more) $500.00 per

 Qty:

 

* This form must be digitally signed to register.

This health info is correct as far as I know and the person listed has permission to attend Youth Music Camp 2008 and to engage in all camp activities except as noted.  I hereby authorize staff or designated medical professionals to administer emergency medical assistance if I cannot be reached.  I accept all payment of expenses incurred as a result of medial treatment.  I authorized professionals to dispense over the counter medications as needed to the camper listed above.  I hereby irrevocably consent to and authorize the un-restricted use and reproduction by you or anyone authorized by your, of any and all photographs and/or video images which you have taken of the camper listed above for use within Salter’s Christian Music Ministries.

* Digital Signature of Parent/Guardian

Full Name:  

NOTE:  Refund will not be automatically given.  Request must be made in writing within 5 days prior to the event.  There will be a $10

charge for each cancellation.  Substitutions are allowed and can be done by phone.  Full medical disclosure is required.  If full medical disclosure is not made in advance, the camp staff will be directed to refuse camper and the parents will be required to pick up camper immediately.

 

 
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