We are proud to announce the 2nd Annual
DPISD Elementary Summer Music Camp
For students entering 3rd – 6th grades
We will be offering THREE sessions.
Each session meets Monday –Thursday 9am to 2pm
San Jacinto Elementary Gymnasium
1302 East 13th Street
Deer Park, TX 77536
Session 1: June 22 – 25, 2015
Destination America! A Coast-to-Coast Musical Tribute
The music of America tells its story…from Nashville to Seattle, New York to L.A. So get on board for a
musical road trip as we celebrate America and its song!
Session 2: July 6 – 9, 2015
Let’s Jam! It’s Our Band
We want to form a band and play for you! But, we don’t know what kind of band we want to be! Come
on down to the Twist and Shout and explore some great country, reggae, Motown, surf and blues like
you’ve never heard it before!
Session 3: August 3 – 6, 2015
Today’s Hits! A Modern Pop-Show
Join us for some fun while we sing and dance our way through today’s popular music such as
Bruno Mars, Katy Perry, Sheppard, Bon Jovi and Journey! This show is guaranteed to be a good time!
Final performances will be at 6:00 pm in the San Jacinto Elementary gym on THURSDAY.
Registration cost is $120 and includes: one camp t-shirt*, one camp water
bottle*, a tote bag*, one cd with music book, a daily snack and drink.
*shirts, water bottles and totes only guaranteed for those who register by May 22, 2015
MULTIPLE SESSION EARLY BIRD SPECIAL! Sign up for more than 1 session
of camp by May 1 and receive a discount! Only $220 for two sessions, or
$300 for all three!
Hurry, space is limited. Each session will be closed when we reach 50 participants.
Reserve your spot today! Contact lshearon@dpisd.org or syarberry@dpisd.org if you have
any questions.
Important Information
Students must provide their own transportation to and from camp. Please bring
your student in to the SJE gym on the first day to check-in and receive a car tag. All
other camp days, students can be dropped at the door.
STUDENTS MUST have a car tag to be picked up from camp.
Students need to bring a sack lunch every day of camp. A daily snack will be
provided at camp. Please fill out the registration form and the medical release
form and return to your student’s school music teacher along with the
registration cost of $120. Checks can be made out to San Jacinto Elementary with
Music Camp and student name in memo. We will accept registration until we
meet our cap of participation.
MULTIPLE SESSION EARLY BIRD SPECIAL! Sign up for more than 1 session
of camp by May 1 and receive a discount!
Only $220 for two sessions, or $300 for all three!
*Students who sign up for multiple sessions will only receive 1 t-shirt, 1 tote, and
1 water bottle. Additional items can be purchased.
Hurry, space is limited. Each session will be closed when we reach 50 participants.
Reserve your spot today! Contact lshearon@dpisd.org or syarberry@dpisd.org if you have
any questions.
2015 DPISD Elementary Music Camp Registration
For students entering 3rd – 6th grades
Please fill out this form and return to your school music teacher before May 22th to guarantee a shirt,
water bottle and tote.
**please print information CLEARLY**
Student Name
Age:
Grade entering
in 2015-2016
Parent/Guardian Name
Primary contact phone #
Secondary contact phone #
Emergency Contact name
Primary contact phone #
Secondary contact phone #
Parent email
Session 1
Session 2
June 22 – 25
July 6 – 9
(circle all that apply)
Session 3
August 3 – 6
Student’s T-shirt size (included in camp registration)
Circle one:
YS
YM
YL
AS
AM
AL
AXL
Additional items (1 included with registration)
T-shirt: ____YS
____YM
____YL
Water Bottle: ________(quantity)
____AS
_____AM
____AL
____AXL
Tote: ________ (quantity)
Registration Cost:
$120
***EARLY BIRD SPECIAL*** 2 sessions for $220; 3 sessions for $300
(must be turned in by May 1 to receive this discount)
Additional Water Bottle:
$5
Additional Tote:
$10
Additional t-shirt:
$10
Total Due:
$
$
(Checks can be made out to San Jacinto Elementary with Music Camp and student name in
memo.)
$
$
$
$
Hurry, space is limited. Each session will be closed when we reach 50 participants.
Reserve your spot today! Contact lshearon@dpisd.org or syarberry@dpisd.org if you have
any questions.
MEDICAL RELEASE FORM (MINORS)
Name_________________________________Date of Birth__________________
Parent/Guardian Name (If applicable)________________________________
Address____________________________________________________
Telephone Numbers: Home: _________________ Work:____________________
Please indicate another person to contact in the event of an accident
Name________________________________ Phone_______________________
Insurance Company_________________________ Policy Number___________________
Are you presently on any medication? ________________________________
(If yes, please list medication)
Drug Sensitivities______________________________________________
Other Allergies(including food allergies)_______________________________________________
Please read the alternative statements below and sign under the one that you choose. Do Not
sign more than one!
1. If my child needs medical attention, it is my wish that I am contacted before any medical
procedures are done on my child, unless immediate treatment is necessary to save my child’s
life or to prevent permanent injury.
Signature of Parent/Guardian_________________________________________________
Date___________
2. If my child needs medical treatment while participating, it is my wish that the treatment be
begun while efforts are being made to contact me. So that treatment is not delayed, I consent to
any medical procedures that the physician believes needed, on the understanding that efforts
will continue to be made to contact me. I accept responsibility for all cost related to such
treatment.
Signature of Parent/Guardian_________________________________
Date___________
Hurry, space is limited. Each session will be closed when we reach 50 participants.
Reserve your spot today! Contact lshearon@dpisd.org or syarberry@dpisd.org if you have
any questions.