This space for office use only:
2016 Camp Application
Camp Dates: June 21 – June 25, 2016
Order ID # ________
Date Recvd: _____ / _____ / ______
Pmt Type: _____________________ Amount $ ____________
Housing: ❒OFF ❒ON Room __________
Notes:
Application is available ONLINE at ttuchoircamp.org! Or you may print and mail in a hard copy of this
application. Print and complete the Health & Camp Agreement Form and fax or mail asap. Majors are firstcome, first-served. Final Enrollment & Payment Deadline: June 1, 2016.
Camp Confirmation and receipt will be sent VIA EMAIL ONLY from choircamp@ttu.edu
Input: ____________ Health Form: ❒
about the camper…
First Name: __________________________ Last Name: _______________________ School in Spring ’16: __________________________________________________
Nickname (for Nametag): _______________________________________________ School in Fall ’16: _____________________________ Grade (Fall ’16): ________
Mailing Address: _____________________________________________________
City: ____________________________ State: _________ Zip: ______________
Student Email: _______________________________________________________
Home Phone: ___________________ Student Cell Phone: ___________________
Date of Birth ______ /______ / ______ Gender _______
Voice Part: ❒Sop I ❒Sop II ❒Alto I ❒Alto II ❒Ten I ❒Ten II ❒Bass I ❒Bass II
Check all of the following which apply to you for the school year 2015-2016:
❒All Region Choir ❒Top Ten in Region ❒Qualified to Area ❒All State Choir
❒Choir Officer
❒Member of other school Music Ensembles
please list: ________________________________________________
How were you referred to TTU All State Choir Camp:
❒ Returning Camper ❒ Poster/Ad ❒ Website ❒ Sibling or other relative
❒ Director/Private Lesson Teacher: ______________________________________
about the camper’s parent/guardian… (please list primary contact first)
PARENT/GUARDIAN 1: (primary contact)
First Name: _____________________ Last Name: __________________________
Mailing Address: _____________________________________________________
City: _________________________ State: _________ Zip: __________________
Email: _____________________________________________________________
Home Phone:________________________________________________________
Work Phone: ________________________________________ ext. ____________
Place of Business: ____________________________________________________
Cell Phone: _________________________________________________________
PARENT/GUARDIAN 2:
First Name: _____________________ Last Name: _______________________
Mailing Address: _____________________________________________________
City: _________________________ State: _________ Zip: ___________________
Email: ______________________________________________________________
Home Phone:________________________________________________________
Work Phone: ________________________________________ ext. ____________
Place of Business: _____________________________________________________
Cell Phone: _______________________________________________________
In case of emergency and parent or guardian is unavailable, contact: Name __________________________________________________________________________
Relationship to camper: ____________________ Day Phone: ______________________ Evening Phone: _____________________ Cell phone: __________________
TTU All State Choir Camp * Box 42033 * Lubbock, TX 79409 * Phone: (806) 742-2225 * Fax: (806) 742-4193 * choircamp@ttu.edu
TTU All State Choir Application 2016, p. 2
LAST NAME, FIRST NAME
housing… ❒ ON - Campus
❒OFF - Campus
(If NOT staying with parent/guardian, provide information of adult responsible
for student during camp)
Name __________________________________________________________
Roommate Preference _______________________________________
If your preference is not available, do you wish to be placed
with someone from your school (if possible)? ❒ YES ❒NO
Relationship to Camper _____________________________________________
Telephone ________________________________________________________
Address __________________________________________________________
Adult T-Shirt Size (included for all campers): ❒Small
❒Medium
❒Large
❒X-Large
❒2X ❒3X
payment information…
METHOD
❒Personal Check - Payable to Texas Tech Choir Camp (include DL#)
❒Cashier’s Check/Money Order
❒ Credit Card: (Circle)
Discover
MasterCard
Visa
American Express
Card #: ___________________________________________________________________________
Name on Card _____________________________________________________________________
Exp. Date (mm/yy) ______________ Verification Code: __________
Billing Address (if different from above): ________________________________________________
PAYMENT AMOUNT
❒ Deposit Only ($100 – NON-refundable)
Balance due by June 1
$________________
❒ Full Amount Now ($390 ON-Campus; $190 OFF-Campus)
$________________
$25 late-registration fee applies after June 1
PRE-PURCHASE OPTIONS
___ CD of Final Performance: $15
___ Parking Sticker: $10
___ Airport Shuttle: $15 each way
$________________
$________________
$________________
TOTAL (amount enclosed or authorized payment)
$________________
❒ Parent & Student signatures
ON-Campus: $390 (includes housing, meals, and all
activities, DOES include music packet)
$100 non-refundable deposit due w/ application
$330 balance due by June 1
OFF-Campus: $190 (DOES include music packet)
$100 non-refundable deposit due w/ application
$90 balance due by June 1
$25 late-registration fee applies AFTER June 1
MAILING ADDRESS
TTU All State Choir Camp
Box 42033
Lubbock, TX 79409
****Make sure the following is enclosed before mailing *****
❒ Health Form/Elective Choices ❒ Appropriate fees enclosed or credit card info listed
❒ Copy of health insurance card
TTU All State Choir Camp * Box 42033 * Lubbock, TX 79409 * Phone: (806) 742-2225 * Fax: (806) 742-4193 * choircamp@ttu.edu
2016 Health Form & Camp Agreement
For Office Use Only
Complete: ❒
Reg #: ________ Date Rcvd: ___________
Housing: ❒ON ❒OFF Room #: _______
Application cannot be processed until this form is completed in its entirety by parent/legal guardian, signed, and returned.
If necessary, please update this information with nurses on registration day. Form Deadline: June 1, 2016
Student Name (Last, First) _________________________________________________ Nickname on Nametag (if different) ______________________________ Gender: __________
Name of Insured (Financially responsible party with authority to make medical decisions): ___________________________________________________________________________
Relationship to student: ____________________________________________________
Contact Phone: _____________________________________________
Please copy both sides of your insurance card and enclose OR Fill in the following
Provider (if none, state “Not Applicable”): _____________________________________ Group #________________________________
Family Doctor: _________________________________________________ __________________________________
Name
City
Please continue on the back if necessary
Date of last Tetanus _____________
________
State
Policy #_________________________
__________________________________
Telephone
PREEXISTING CONDITIONS: _________________________________________________
MEDICATIONS: __________________________________________________________
_________________________________________________________________________
Allergies to food or medication: ____________________________________________
_________________________________________________________________________
* Campers requiring emergency treatment will be taken to the University Medical Center emergency room unless otherwise specified. Every effort will be made to
contact a parent/legal guardian prior to seeking medical attention; however, the registered nurse will make the decision to proceed based on the safety and welfare of
the camper. Parents are responsible for all medical expenses. Please provide the most current insurance information.
* The camp clinic will have a limited supply of over-the-counter medications for aches/pains, upset stomach, allergies, etc. Campers MAY NOT self-administer
medications for the following: antidepressants, any controlled substance (including prescription pain medication), and medication for ADD/ADHD. These must be
administered through the camp clinic. ALL medications should be properly labeled and in the original container. Please be sure that the student is aware of the proper
use of all medications and medical equipment brought to Camp. The Camp is not liable for their loss.
_____ My son/daughter will self-administer his/her medication while at camp. I understand that these medications will not include any medications for the abovenamed drug categories.
_____ My son/daughter will be taking medication that requires the camp nurse keep and administer the medication. (Please provide detailed instructions.)
In case of accident or sudden illness/injury to the above-named child and in the event that I cannot be reached by phone, I hereby authorize a representative of Texas
Tech All State Choir Camp to seek medical treatment for my child. I hold the Texas Tech All State Choir Camp, its employees, and Texas Tech University harmless from
all liability resulting from any accidents or illness to my child. I verify that all information on this form is complete and accurate. I have read and understand all
information contained herein.
__________________________________________________________ ___________________________
Authorized Signature of Parent/Legal Guardian
Date
TTU All State Choir Camp * Box 42033 * Lubbock, TX 79409 * Phone: (806) 742-2225 * Fax: (806) 742-4193 * choircamp@ttu.edu
*
www.ttuchoircamp.org
________________________________________________________
Camper Last Name, First Name
For Office Use Only
________________________________
Health Form: ❒
Date Rcvd: ___________
Order ID
Complete: ❒
selection of camp major…
All campers will choose a “Major” for camp instead of electives. Each Major will include going to two electives during the camp.
Please indicate your 1st and 2nd preference. *Please note, majors will be assigned on first come first served basis*
______ PERFORMANCE (Music Theater & Opera)
______ MUSIC EDUCATION (Choral Conducting & Leadership)
______ THEORY & COMPOSITION (Composing/Arranging & Music Theory)
______ VERNACULAR MUSIC/DANCE
vocal performance master class…
Campers may choose to participate in a vocal performance master class with one of the TTU Voice Faculty members. The master class is limited to 12 students
who bring a memorized solo with them to camp (art song or aria appropriate for Solo & Ensemble Contest). Participation is first-come, first-served by the date
your application is received.
______ YES, I would like to participate in the Vocal Performance Master Class.
Solo Selection: _____________________________________________________________________________________________________________
Title
Composer
*Please email choircamp@ttu.edu if you need to change your solo selection prior to camp.
agreement… We understand the following:
• All information contained herein is complete & accurate
• $100 registration deposit is NON-refundable
• All fees are due by June 1
• No housing refund will be made after June 1
• Late medical withdrawals require a doctor’s statement
• $25 LATE registration fee applies after June 1
• No refund will be issued for now-shows or early withdrawals
• Use or possession of alcohol, any illegal substance, firearms, or other weapons will constitute immediate dismissal from the camp with no refund and
appropriate police action WILL be initiated.
_______________________________________________________________
Parent/Legal Guardian Signature
_______________________________________________________________
Student Signature
These completed forms must be received by June 1, 2016. Forms may be faxed, emailed, or mailed to the address below.
TTU All State Choir Camp * Box 42033 * Lubbock, TX 79409 * Phone: (806) 742-2225 * Fax: (806) 742-4193 * choircamp@ttu.edu
*
www.ttuchoircamp.org