Student Application

First Name:
Last Name:
Parent/Guardian Home Phone:
Parent/Guardian Work Phone:
Cell Phone (parents):
E-mail (parents):
Age (in July):	Sex: Female Male
Address:
Address 2:
City:
State:	Zip/Postal Code: Country:

Grade in School (Sept. '12):
Name of School:
Address of School:
Address 2:
City:
State:	Zip/Postal Code: Country:

Major Instrument/Voice:		Years Studied:
Minor Instrument/Voice:		Years Studied:

School Music Teacher's Name:
School Music Teacher's Address:
Private Music Teacher's Name:

Private Music Teacher's Address::
(name)	(address)	(city)	(state)	(Postal Code)

A friend who may be interested in attending:
(name)	(address)	(city)	(state)	(zip)

Classes offered include:  Theory, Harmony, Beginning Theory, Composition/Arranging, Improvisation, and Conducting. Selection to be made on Registration Day. Our faculty will assist you with your selection..

How did you learn about Eastern U.S. Music Camp? (please be specific as how you heard about our program helps reach music students such as yourself)

How did you find the Eastern U.S. Music Camp Website?

I PLAN TO ATTEND (check one): 2 weeks -------------> 3 weeks -------------> 4 weeks ------------->

BEGINNING SUNDAY (check one - do not omit): June 24 - July 8  July 1 - 15   July 8 - 21 June 24 - July 15  July 1 - 21 June 24 - July 21

Maximum enrollment: 200 students per two-week session.

The cost of my program is (press arrow to right for 2-3-4 week fees): ** Resident: Includes Instruction, campus health services, Room & Board ** $2,214 for two weeks $3,321 for three weeks $4,428 for four weeks ** Day Student: Includes Instruction, campus health services, & Complete Program with Lunch ** $995 for two weeks $1,492 for three weeks $1,990 for four weeks

Applications are accepted on a first-come, first-serve basis. By submitting this form, I understand that upon receipt of your Eastern U.S. Music Camp Student Application and Registration Fee, no refunds or deductions for the cost of the program will be made for any reason including cancellation, late arrival, early departure, sickness or expulsion for disciplinary reasons as explained by the rules distributed upon arrival by the Eastern U.S. Music Camp, Colgate University, federal, state and local law.

Camp Regulations/Certification/Policy: All Eastern U.S. Music Camp participants are required to comply with Camp and College rules and regulations and any federal, state, and local law.  Rules will be distributed and explained upon arrival in Hamilton.  Violations or misconduct will result in immediate dismissal from Camp without refund.  * EUSMC does not discriminate on the basis of sex, race, color, national or ethnic origin, religion or physical handicap. The program has been inspected and certified by the New York State Department of Health for 36 years.

To make a reservation, please mail the non-refundable deposit of $395 (part of total cost) along with the printed application.   The deposit is part of the total cost.  The balance must be paid by June 9, 2012. All checks should be made payable to Eastern U.S. Music Camp, Inc. Please mail the deposit or full amount to the address below. (Credit may be earned when enrolled in the full four-week program.)

Signature of Parent/Guardian: ______________________________________________________________ Date: ________________________

Please mail all applications, deposits, and balances to:
Eastern U.S. Music Camp, Inc.
7 Brook Hollow Road
Ballston Lake, NY 12019

For further questions, you are always welcome to call:
Toll Free: 1-866-777-7841
Tel. 1-518-877-5121
Fax. 1-518-877-4943
E-mail: summer@EasternUSMusicCamp.com

Summer Address (June 24-July 21, 2012)
Colgate University
Dana Arts Center
Hamilton, NY 13346-1398
Music Camp Office
Summer Telephone: 315-228-7041
Summer Fax: 315-228-7557