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410 26th Ave NE Hickory, NC 28601

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Summer Music Camp Registration
Ages 7-12

Please fill out one form per child attending.

Child's First Name

Child's Last Name

Birthday * required

Age

Parnet First and Last Name

Phone

Parent Email

Street Address

City

Postal / Zip code

Region/State/Province

Country

Does your child have any allergies?

If YES please provide further details

Please list all adults who can sign child out of music camp

Emergency Contact Name and Phone Number:

I give permission for The Chapel Church to photograph/video my child during camp and to use these images in printed materials, online platforms, and other promotional channels.

I do NOT give permission for The Chapel Church to photograph/video my child during camp or to use their image in any promotional materials.

828-855-1777 admin@thechapelhickory.com 410 26th Ave NE Hickory, NC 28601

Office Hours: Monday-Wednesday 10am-2pm

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