This website is best viewed in a browser that supports web standards.

Skip to content or, if you would rather, Skip to navigation.

Northwest Missouri State University

  • myNorthwest

High School Music Camp Registration

High School Camp: June 8-13
Entering grades 10-13 (college freshman) in 2009-10
Entry Deadline: June 1

*All fields are required except for roommate choice and additional purchased items.

Camper Information:

Type of Camp: Resident Camp ($340)
Commuter with meals ($210)
First Name:
Last Name:
Gender: Male  Female
Age:
Name of School:
Grade in School:  (for 09-10)
How many years have you attended Northwest's Music Camp (including this year)?
Birthdate:  (format: MM/DD/YYYY)
Polo Shirt Size: (included in camp fee)
E-mail Address:
Confirm E-mail Address:
Note: We will communicate camp updates through e-mail.
Daytime Phone:

Roommate Request

If attending as a resident camper, what is the name of student with
whom you wish to room:
 (optional)

Parent Information:

First Name:
Last Name:
Address:
City:
State:
ZIP Code:
E-mail Address:
Confirm E-mail Address:
Note: We will communicate camp updates through e-mail.
Daytime Phone:

Camp Activities:

Were you a member of the 2008-09 High School Music Educator Association
All-State organization? (scholarship valued at 50% of camp fee)
Yes No
Were you a member of the 2008-09 High School Music Educator Association
All-District organization? (scholarship valued at $30)
Yes No
What state did you participate in?
What ensemble did you participate in?

If you participated in more than one district ensemble, please choose one for the purpose of this application.		 Choir
Band
Jazz Band
Orchestra
I did not participate
Name of instrument you play: Concert Band:
Orchestra:
Jazz Band:
None
Voice Part:

Soprano
Alto
Tenor
Bass
None

The ensemble(s) in which you wish to participate. Required Large Ensembles:
Band
Choir

Elective Ensembles:
Jazz Band
Show Choir
None

Optional Purchases:

Note: All optional purchases must be paid for today.

Would you like Private Lessons? Cost: $10 per 30-minute lesson

Yes No

What type(s) of lessons would you like?

Vocal
Number of Lessons:
Voice Part:
Instrumental
Number of Lessons:
Instrument:
None    

Would you like a Commemorative Camp T-Shirt? Cost: $15 per shirt

Yes No
How many t-shirts?

 

Would you like to pre-order a CD or DVD Recording of the concert?
Cost: $13 single CD; $20 two-CD set; $15 for single DVD; $22 for two-DVD set

Yes No

What type(s) of recordings would you like to preorder?

Friday Chamber Concert
Quantity of CD:
 Cost: $13
Quantity of DVD:
 Cost: $15
Saturday Finale Concert
Quantity of CD:
 Cost: $13
Quantity of DVD:
 Cost: $15
Two Disc Set
Quantity of CD:
 Cost: $20
Quantity of DVD:
 Cost: $22
None    
Recordings will be shipped to address provided above in 6-8 weeks after camp completion.

Authorization for Medical Treatment:

I give permission for my child, named above, to be treated by the Northwest Missouri State University physicans and further authorize treatment at St. Francis Hospital in the event my child needs treatment the university physicians are unable to provide while in attendance at Northwest's Music Camp of Excellence.

Does your child have allergies to medication or food?
No
If yes, state:

Does the student require any special treatments or medication?
No
If yes, state:

Does your child have a chronic illness or disability?
No
If yes, state:

Do you give permission for the staff at the camp to administer over-the-counter medication (headache tablets, upset stomach formulas, etc.) in the event your child required medications?
No
Yes

Is the child covered by health insurance?
No
If yes, please provide the following information:
            Company Name:
              Policy Number:

If your child requires specialized care or treatment, written permission from a family physician must accompany your child so that we may ensure care. Nortwhest Missouri State University Music Camp of Excellence is not responsible for payment of treatment.

Fee Information:

  • Minimum deposit of $170 required for residential campers.
  • Minimum deposit of $105 required for commuter campers.
Payment Option: I would like to pay the camp fee in full.
I would like to pay the camp fee in two
     installments.

Camp Fee: $
Scholarship Awarded: $
Optional Purchased Fees: $  
Amount Due Today: $ (camp fee + optional purchases)
Remaining Balance: $

Billing Information:

I would like to use the Parent Information above for the Billing Information.
Yes No
*First Name:
*Last Name:
*Street Address:
*City:
*State:
*ZIP Code:
*Phone:
*E-mail:

To retain a copy of this application for your records,
PLEASE PRINT THIS PAGE NOW!