Music Conservatory Application (Page 2 of 2) in pdf

Parent/Guardian Information:

Last Name

First Name

Initial

Relationship

Mailing Address (if different from Student’s Address on reverse)

street

city

state

zip

Home Phone Number

Work Phone Number

Email Address, if available

Emergency Contact Name (Please provide name of individual outside your household)

Relationship

Emergency Home Phone

Emergency Alternate Phone

Important information for parents:

By signing this application, I understand and agree to the rules that will be expected of the above named applicant. I understand that

said camper may be dismissed from camp at the discretion of the Divisional Music Director/Divisional Youth Secretary, and that such

decisions are final.

In the event of an emergency, I authorize The Salvation Army to seek reasonable and required medical care. I understand that in certain

instances, The Salvation Army may seek professional health care services at the discretion of the Divisional Youth Secretary/Divisional

Music Director, in consultation with the Camp Health Care Staff. By signing this application, I authorize The Salvation Army to contact the

Alternate Emergency Contact I have listed above in the event that I cannot be reached. I have confirmed with the alternate contact that

they are willing and able to assume this responsibility.

I understand that, as a component of the Conservatory Program, campers may travel to various locations away from camp (e.g. corps,

amusement parks, etc). By signing this application I authorize my child to participate in such travel directly under the supervision of the

Divisional Music Director and associated personnel.

I have confirmed with my Corps Officer that my child is eligible and will be endorsed to attend this camp. I realize that I may be

responsible for all or some portion of the camp fee, at the discretion of my Corps Officer.

Parent/Guardian Signature:_________________________________________________Date:____________________________

Corps Officer Information

By signing this application, the Corps Officer acknowledges the following statements and requirements for Carolina’s Music Conservatory 2012:

The Corps (by way of the Corps Officer) fully endorses the applicant;

•

The Corps will furnish the applicant with any instrumentation that may be required (instrumental majors only);

•

The Corps will provide additional training and instructional activities throughout the year;

•

Should disciplinary issues require, the Corps Officer will arrange transportation for dismissed students when parents/guardians are

•

unable to do so.

If submitting multiple applicants, please indicate the in order in which you would suggest the music department accept the application.

•

The corps officer also understands that, given the intensive nature of the Conservatory program, priority will be given to students that are actively

involved in music and arts programs at the corps, regional, or divisional level; not necessarily in the order that applications are received.

Signature of Corps Officer: __________________________________________________ Date:___________________________

CORPS OFFICERS:

Return This Signed Application by One of the Following Methods:

Email: Scan and email the document to Jennifer Goude (Lotus Notes)

Mail:

The Salvation Army

Fax: 704-972-3534

Attn: Jennifer Goude

ATTN: Jennifer Goude

501 Archdale Drive

Charlotte, NC 28217

Music Conservatory Application Page 2

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