4-10 July 2021
Texas Tech University School of Music
US/Central timezone
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Registration Form

Please, note that fields marked with * are mandatory


Camper Participant Information
 
Camper Tuition Fee *

Personal Information

Student First Name: *
Student Last Name: *
Middle Name:
Nickname (for name tag):

Mailing Address: *
City: *
State: *
Zip Code: *
Email: *
Home Phone:
Cell Phone: *
DOB: *
 MM/DD/YYYY
Gender: *
T-Shirt Size: *

Drum Major (all day)/Instrument
If you selected Instrument above, please answer the following two questions:

Choose an Instrument:
# of Years Playing Experience

What school did you attend in the Spring of 2021? *
If unsure or moving, please state so.

What school will you be attending, starting this Fall of 2021? *
If unsure or moving, please state so.

What grade will you be in, starting this Fall of 2021? *

Were you an All-State Member during 2020 - 2021? *
If you selected Yes above, pending verification, you are eligible for a tuition scholarship. Once your status is verified, you will receive an email with your new balance.

How were you referred to TTU Band/Orchestra Camp? *

If you selected director, private lesson teacher,
returning camper, sibling or other relative, website,
or other above, please elaborate on your choice:

Parent/Guardian Information
 

Parent/Guardian 1: (Please list primary parent first)


First Name: *
Last Name: *
Mailing Address: *
City: *
State: *
Zip Code: *
Email Address: *
Home Phone:
Business (Work) Phone:
Phone Extension
Place of Business
Cell Phone: *

Parent/Guardian 2: (optional - leave blank if none to list)


First Name:
Last Name:
Mailing Address:
City:
State:
Zip Code:
Email Address:
Home Phone:
Business (Work) Phone:
Phone Extension
Place of Business
Cell Phone:

Emergency Contact (Required)
 
For use when parent or guardian is unavailable

First Name: *
Last Name: *
Daytime Phone:
Evening Phone:
Cell Phone: *

Medical and Insurance Information
 

Name of Insured:
(Financially responsible party with
authority to make medical decisions)
*

Relationship to Student *
Contact Phone Number: *

Provider (if none, state "Not Applicable"): *
Provider Group Number:
Provider Policy #:

Family Doctor: First & Last Name
Family Doctor: City and State
Family Doctor: Phone Number

Date of last Tetanus: *
 MM/DD/YYYY
Preexisting Conditions:
Medications
Allergies to food or medications

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.

Administration Choice: *
My son/daughter will self-administer his/her medication while at camp. I understand that these medications will not include any medications for the above named drug categories.
My son/daughter will be taking medication that requires the camp nurse to keep and administer the medications. (Please provide detailed instructions.)

Medication administration instructions, if applicable

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 Band & Orchestra Camp to seek medical treatment for my child. I hold the Texas Tech Band & Orchestra 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.
*
I agree

Lubbock Airport Shuttle
 
This price covers the cost for to and from the airport shuttle.

Lubbock Airport Shuttle

*
  15.00 USD

On-Campus Housing
 

On-Campus Housing

*
  370.00 USD
Who would be your preferred roommate during
Band & Orchestra Camp?

Optional Fees
 
Recording of Final Performance
Parking Sticker
Camp Patch
Instrument Storage
Instrument Rental (Includes Storage)
Additional Camp T-Shirt
Charter Bus TO Camp
Private Lesson
Commuter Only Lunch Card -
Do not purchase if staying on campus

Promo Codes
 
If you have a promo code/discount, do not pay after clicking the register button below. Please email Charles Olivier with your promo code and wait for an updated payment link.