Student information:

*Name

Male: Female:

*Age

*Address

*City

Select State Alabama Alaska Arizona Arkansas Califonia Colorado Connecticut Delaware Florida Geogia 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 Wisconson Wyoming *State

*Zip

*E-mail Address (if available)

*Phone Number

Cell (Optional)

Select Instrument Keyboard Trumpet French Horn Trombone Baritone/Euphonium Tuba/Sousaphone Violin Viola Cello String Bass Flute Clarinet Alto Saxophone Percussion Tenor Saxophone Baritone Saxophone Bass Clarinet Recorder *Instrument

*Number of Years Played

Summer Band and Orchestra Camp at Champions Covenant Church

Select Location Tomball – Rosehill Spring Clear Lake Sugarland Tomball - New Hope Katy Copperfield Conroe – Covenant Conroe – CAJA *Location for semester classes

I have read and agree to the rules and guidelines and the fee policy of Instruments of Praise.

Parent infomation:

*Father's Name

*Mother's Name

*E-mail Address (if available)

*Phone Number

Cell (Optional)