UT Arlington
Summer Concert Band Camp Application

PARENT/GUARDIAN INFORMATION

 Date:

Parent Name:
Parent Home Telephone:
Parent Work/Daytime Telephone:
Parent Email:

CAMPER INFORMATION

Camper First Name: Camper Last Name:

Sex: Male Female

Instrument:

Street Address:
City: State: Zip:

Name of Current School:
Grade in FALL 2008
Name of Current Band Director:
Band Director Telephone:

All students MUST participate in one elective. Select your preferences (first, second, third choice).
BE SURE TO CHECK THE REQUIREMENTS LISTED FOR EACH.
For descriptions, see the camp information packet available for download on the previous page.
Elective First Choice:
Elective Second Choice:
Elective Third Choice:

If you chose Jazz Performance as an elective, please list other jazz band instruments you play (piano, bass, drums, etc.)

Boarding campers may select their roommates.
Dorm rooms are configured for either 2 or 3 per room. If you list one roommate choice, we will try to put you in a double. If you list two roommates, we will try to put you in a triple. All roommates must request each other for requests to be honored. We cannot guarantee that all roommate requests will be honored.
Roommate Choice #1:
Roommate Choice #2:

T-Shirt Quantity:
T-Shirt ADULT Size:
T-Shirts are $15 per shirt and must be paid in advance.

PLAN AND PAYMENT INFORMATION

Student Camp Plan (Commuter or Boarder):

I will pay now: Full Amount listed above Only non-refundable deposit ($25)

FULL PAYMENT MUST BE RECEIVED BY FRIDAY, JUNE 6. See the camp information packet for refund schedule.

Method of Payment:

Cash: Accepted in person at UTA Band Office only.
Checks/Moneyorders: Accepted in person and through US mail.
Credit Card: Call 817.272.2533 with your credit card informationWe will need the following information when you call:
Cardholder Name
Card Number
3-digit Security Number on back of card
Expiration Date
Billing Street Address
Billing City, State, Zip
Card Type (Visa, Mastercard, American Express, Discover)

When you click on the "submit" button below, you application will be sent to our office and you will be forwarded to an informational page which will tell you how to complete your camp registration. Please read that page carefully and follow the instructions. There are additional forms that must be filled out and returned to us by the start of camp.