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Gold Country Music DAY Camp July 1115, 2016 We are pleased to offer a day camp at Columbia Elementary School open to all Tuolumne County band students entering grades 69 with enough instrumental skills to perform in a beginning band or higher. The camp will run from Monday, July 11 to Friday, July 15 ending with a concert performance by students on Friday evening. PROGRAM Gold Country Music Day Camp is organized to challenge and entertain students in a variety of creative pursuits, and is devoted to the development of musicianship for students grades 69. This will be accomplished through classes, concentrated rehearsals, performance, recreation and general day camp life. The curriculum includes instrumental techniques, large and small ensembles, music theory, Jazz Band, Choir and more. Classes will be offered daily from 8:00 AM to 5:00 PM and will be taught by local musicians and music educators. FACILITIES Columbia Elementary School has kindly allowed us to use their wonderful facilities. Students are asked to bring a sack lunch and water bottle each day. Additional snacks and drinks will be provided daily. Students will also be responsible in helping clean up after lunch and breaks. It is important that we are respectful and leave Columbia School clean and undamaged after our visit. RECREATION Each afternoon, we will have access to the Columbia Pool. Campers are encouraged to enjoy the pool and spend some social time with other campers and staff. Those who would like to swim should bring appropriate swim apparel, a towel and sunscreen each day. It is important to let our staff know, on the application form, if and when your child may miss the swim hour due to schedule conflicts. MUSICAL NEEDS Students should bring their own instrument. If you do not have one, please make arrangements to borrow or rent one. This also applies to snare drummers. Marching and elective equipment (except guitar) will be provided. APPLICATION The completed application and school waiver form along with full payment of $85.00 must be made payable to Sonora High School and mailed to Gold Country Music Camp, Attn: Yvonne Denton, C/O Sonora High School, 430 N. Washington St. Sonora, CA 95370 . Final camp application deadline is May 27.Due to limited space, applications will be accepted on a first comefirst served basis. Please call Yvonne Denton 5325511 x451 or email
[email protected] with any questions.
CAMP APPLICATION GOLD COUNTRY MUSIC DAY CAMP July 1115, 2016 Columbia Elementary School Student Name ______________________________________Age _____Gender______ Parent/Guardian Name___________________________________________________ Home phone________________ Work phone_______________Cell phone__________ Mailing address _______________________________City______________ Zip______ Email___________________________________________ School (entering 16/17 ) __________________________ Grade (entering 16/17 )______ Instrument______________________( specify alto, tenor or baritone sax ) Years played__________ Check one: ___Beginning Band (grades 67, or played only 1 year) ___Intermediate Band (grades 89) Camp Tshirt (adult sizes) circle one: S M L XL (camp picture included) Possible electives you would be interested in (mark your top 3 choices number 1, 2 and 3): _____Jazz Band _____Drum Line (drummers only) _____Boomwhackers (pitched percussion tubes) _____Glee (singing/dancing) _____Ukulele _____Drum Major _____Flute Ensemble (flute players only) _____Beginning Guitar (students will need to provide their own guitar) _____Intermediate Guitar (students will need to provide their own guitar) (Electives are selected by interest and staff available). _____Yes, my child has permission to participate in swimming activities at Columbia Pool. _____Yes, my child knows how to swim. _____No, my child does not know how to swim. My parent/guardian signature below acknowledges that my child will follow school rules and pool rules during camp hours. My child will swim on the following days (please circle yes or no): Monday Y N Tuesday Y N Wednesday Y N Thursday Y N Friday Y N Parent/Guardian Signature_________________________________________________ Music Teacher Signature___________________________________________________ Please list any days/times your child may need to be picked up early from camp. Official Use Only: Date Received_________ CK #___________________ Cash___________________ Amount________________
Gold Country Music DAY Camp Schedule 8:00 – 8:45 8:45 – 10:00 10:00 – 10:15 10:15 – 11:15 11:15 – 12:00 12:00 – 1:00 1:00– 2:00 2:00 – 2:30 2:30 – 4:00 4:00 – 5:00 5:00
Marching Rehearsal Break/Snack Sectionals Chorus Lunch Electives Theory/Guest Performances Rehearsal Pool/Snack Parent Pick Up at pool
6:00 PM Friday, July 15 Camp Concert Performance for families. Campers will be provided pizza dinner at 5:00 PM before the concert. Campers go home with families after the concert.
*REMINDER: No cell phone use during camp hours. Cell phones may only be used if necessary at the 5:00 PM Parent pick up time. School rules apply during camp. Please make sure that our staff is aware of any schedule conflicts on the previous application page so we may easily keep track of all students and more carefully account for our camp costs such as the pool use fees. Students must be signed in and out of camp each day.
COLUMBIA UNION SCHOOL DISTRICT WAIVER, RELEASE AND INDEMNITY AGREEMENT FOR PARTICIPATION IN VOLUNTARY ACTIVITY Participant:______________________________________________________________ Name of School:__________________________________________________________ Description of Activity:____________________________________________________ Date(s) of Activity:________________________________________________________ By my signature below, I hereby give permission for my son/daughter to participate in the abovedescribed activity. I understand that this activity is voluntary and is not part of the Columbia Union School District (District) curricular or extra curricular program. I understand that this activity could cause serious illness and/or injury or death, and I assume all risks for any such illness and/or injury or death. I am aware that no Districtauthorized supervision or oversight is being provided for the abovedescribed activity. I am aware of the transportation arrangements for this activity and acknowledge that the District is not providing transportation. The parent/guardian has complete and sole responsibility for approving transportation arrangements. I acknowledge that the District does not provide medical coverage for participants in this activity.
For and in consideration of permitting the above named child to participate in the activity described above, the undersigned hereby voluntarily releases, discharges, waives and relinquishes any and all actions or causes of action for personal injury, bodily injury, property damage or wrongful death occurring to his/her child/ward or him/herself arising in any way whatsoever as a result of engaging in said activity or any activities incidental thereto wherever or however the same may occur and for whatever period said activities may continue. The undersigned does for him/herself, his/her heirs, executors, administrators and assigns hereby release, waive discharge and relinquish any action or causes of action, aforesaid, which may hereafter arise for him/herself and for his/her estate, and agrees that under no circumstances will he/she or his/her heirs, executors, administrators and assigns prosecute, present any claim for personal injury, bodily injury, property damage or wrongful death against the District, its Board or any of its officers, agents, or employees for any of said causes of action, whether the same shall arise by the negligence of any of said persons, or otherwise.
The undersigned hereby acknowledges that he/she knowingly and voluntarily assumes all risks of bodily injury to his/her child/ward or him/herself, as stated, and expressly acknowledges their intention, by executing this instrument, to exempt and relieve the District, its officers, agents, and employees, from any liability for personal injury, bodily injury, property damage or wrongful death that may arise out of or in any way be connected with the abovedescribed activity. I have read and understand the foregoing and have voluntarily signed this agreement. I am aware of the potential risks involved in this activity and I am fully aware of the legal consequences of signing this instrument. ___________________________________ _______________________________________ Parent/Guardian Signature Date _________________________________________ Parent/Guardian Name (Please Print) _________________________________________ Street Address
Participant Signature
Date
_____________________________________________ Phone Number Emergency Contact Phone _____________________________________________ City State Zip Code
Gold Country Music Camp Student Medical Information
Student Name:__________________________________
Special Needs of Student: Medications Required ( If medication or drugs are to be taken by student, list them here.) Name of Drug/Dosage Reason _______________________________ ____________________________________ _______________________________ ____________________________________ _______________________________ ____________________________________ _______________________________ ____________________________________ _______________________________ ____________________________________ Food, Drug or Other Allergies: ( If your child has any allergies, please list below.) Allergy Description of Reaction _______________________________ ____________________________________ _______________________________ ____________________________________ _______________________________ ____________________________________ _______________________________ ____________________________________ _______________________________ ____________________________________
Other Pertinent Health Information Regarding My Child:
Parent/Guardian Signature:_____________________________________
