Amp Camp Registration

Mailing Address:
AmpCamp
Russell Hall 115
University of Northern Iowa
Cedar Falls, IA 50614-0246

Questions? Kevin Droe at kevin.droe@uni.edu or 319-273-3073

All registrations must be paid prior to the camp.

Student Information

Student First Name *

Student Last Name *

Student Age *

Current Grade in School (as of 2017-18) *

Student Pronouns *

Primary Instrument *

Skill Level on Primary Instrument *

Secondary Instrument *

(Only if the primary instrument is full)

Skill Level on Secondary Instrument *

Please tell us about what music you like (e.g. styles of music, songs, artists, bands, groups, etc.) *

T-Shirt Size *

Adult Sizes

All equipment will be provided for students but students can bring their own equipment. Will you be bringing your own instrument? *

Yes

If you're bringing your own instrument, what are you bringing?

Parent/Guardian Information

Parent/Guardian First Name *

Parent/Guardian Last Name *

Name on Credit Card that you'll use for payment *

Street Address *

City *

State *

Zip Code *

Phone Number *

E-mail Address *

AmpCamp is welcoming to all abilities! Please list any special needs or accommodations that we can make to help make the student’s time at AmpCamp enjoyable. For more information regarding disability service, contact Kevin Droe at kevin.droe@uni.edu or 319-273-3073

Accommodations

Please list any special needs or requested accommodations here.

Dietary Restrictions: Does the student have any dietary restrictions, allergies or special dining considerations to note?

Video and Media Release *

Yes, I or my child can be video recorded, photographed or audio recorded periodically for educational and promotional purposes.

No, please do not share any video recordings or photos

Students may be video recorded, photographed or audio recorded periodically for educational and promotional purposes. If this media is shared with another party, student names will not be used. Any use of your child's image on the AmpCamp website will not include last name.

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