*   Required Items

Camper's Name

First Name   *
Nick Name
Middle   (Initial or name)
Last Name   *

Camper's Birth Date

*   (mm/dd/yyyy)

Camper's Gender

Male
Female

Ethnicity (optional)

African American or Black American Indian or Alaskan Native Asian Hispanic/Latino Pacific Islander Other Caucasion/White

Camper's Address

Address Line 1 *
Address Line 2
City *
State  * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
ZIP Code  *

Camper's Phone

Home Cell (include area code)

Camper's E-mail

Musical Part(s)

Not Sure Tenor Lead Baritone Bass CTRL+Click for mutiple selections

Notes and
Roommate Requests
(This is not a guarantee)

Roommate 1
Roommate 2

School Name

*

School Grade
just before camp

8 9 10 11 12 *

Number of previous
Harmony Camps attended

0 1 2 3 4 5 *

Music Teacher Name

Quartet Name
(if applicable)

T-shirt Size

s m l xl 2xl 3xl 4xl *

Video of Performance

Yes
No
Additional charge of $10

Parent/Guardian's
Name

Prefix   (Mr, Ms, etc.)
First Name   *
Middle   (Initial or name)
Last Name   *
Suffix   (Sr, Jr, etc.)

Parent/Guardian's
Address

Address Line 1 *
Address Line 2
City *
State  * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
ZIP Code  *

Mother's Cell

Mothers Work Phone

  (Include area code)

  (Include area code)

Fathers Cell

Fathers Work Pone

  (Include area code)

  (Include area code)

Parent/Guardian's
E-mail

Scholorship Eligability

If you attended the High School Quartet Contest you are eligable for a $50 scholorship. If you won the High School Quartet Contest you are eligable for a $100 scholorship. Please pay the balance (if any) below. Please include $10 if you'd like a DVD of Sunday's performance.

Parent/Guardian
Credit Card

(Optional.  You can also pay by check, phone, sponsor, or scholarship)

Type: Visa Mastercard Number:

Expiration: Month: 1 2 3 4 5 6 7 8 9 10 11 12 Expiration Year: 2008 2009 2010 2011 2012 2013 2014

Amount of Payment:: $

Tuition - $100
DVD - $10

Name on Card: