Barre Town Middle/Elementary School Summer Music Camp
August 14-18, 2006
(print, complete & return)

Name (Last, First, Middle):
 		  
Grade in School (next fall):
 		  
Parent's or Guardian's Name:
 		  
Parent's or Guardian's Signature:  
Address (Street, City, State, Zip):
 		  
Home Phone:  
Work Phone:  
Emergency Name and Phone Number:
 		  
Medical Issues:
 		  
Please check:

___ Band Session /Instrument(s)

___ Choral Session

___ Both Choral/Band Instrument
Fees: $85
Checks payable to: Barre Town Music Camp		 Check # _____________

 Please return this application by May 1, 2006 to:
Adam Sawyer/Peg Mehuron
Barre Town Middle/Elementary School Music Dept.
70 Websterville Road
Barre, VT 05641