Camp Registration - Music and Drama

Basic Information

Camper Information

Camper's First Name

Camper's Last Name

Camper's Birth Date

Camper's Email Address (if applicable)

Camper's Phone (if applicable)

Address Line 1

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Parent Contact

Parent's First Name

Parent's Last Name

Parent's Email Address

Parent's Phone

HIDDEN - Does Camper Meet 12-year-old Cutoff?

Camper Details

Camper's Grade Next Fall

Note: Only certain camp tracks will be available in this form based on the camper's grade. Please see here for more information: https://www.mbu.edu/campus-life/fine-arts/music-drama-camps/

Camper's Gender

T-Shirt Size (adult sizes)

Name of School

Expected Graduation Year

HIDDEN - Camper Type (Automatic)

Camper Type

Will the camper be staying on campus in the dorms?

YesNo

Accommodations

Please indicate which extra nights the camper is staying on campus ($15 fee per night)

Sunday night (arrive no sooner than 7:00 PM, by 9:00 PM for early camper check-in)Friday night (leave Saturday by 8:00 AM)No extra nights required: The camper will check in Monday morning 8:00-11:00 AM and is only staying Monday-Thursday nights

Request Another Camper for a Roommate

Roommate's First Name

Roommate's Last Name

Badger Bus, MKE to Johnson Creek (transportation provided to and from Johnson Creek)?

Need Pickup at Johnson CreekNeed Dropoff at Johnson CreekPlease email finearts@mbu.edu with your schedule and details.

HIDDEN - Camper Type (Final)

Medical Information

Medical Release

You must complete a medical release to be registered for camp.

"I, (type parent's name)..."

"...declare that I am the..."

"...of (camper's name)..."

I hereby authorize the Camp Health Supervisor to dispense over-the-counter medications as per standard medical practice. In case of medical emergency when I cannot be reached by telephone, I hereby authorize the staff of the Maranatha Camps to secure appropriate medical treatment such as X-ray examination, anesthetic, injection, medical or surgical diagnosis or treatment, and hospital care necessitated by injury or illness, while the above-named child is attending a Maranatha camp. I agree to the release of any records necessary for referral, treatment, billing, or insurance. Services are to be rendered to the camper by legally qualified personnel. I hereby affirm that my child has no physical conditions that will limit participation in the full range of activities being planned, except as listed below. I hereby waive and release Maranatha from any and all liability.

Parent/Guardian indicates agreement with above statement electronically by typing their full name here

Medical History

Physical

Yes, my child has had a physical in the last 12 monthsNo, my child has not had a physical in the last 12 months; I understand that a physical is recommended and take full responsibility for my child's health condition

Please enter where your child's physical is on file

Name of Camper's Physician

Physician's Phone Number

Food Allergies (list all)

Other Allergies (list all)

Current Medications (list all)

Pre-Existing Injuries

Please briefly describe pre-existing injuries or other special medical conditions, or activities to be restricted. (Type N/A if not applicable)

Insurance Information

Camper Has Insurance

Insured's Name

Insurance Company

Policy Number

Insurance Phone Number

This section is a statement from parents indicating they do not have insurance coverage for their child.

(camper's name)

IS NOT COVERED BY INSURANCE.

IT IS OUR UNDERSTANDING THAT MARANATHA MUSIC AND DRAMA CAMPS WILL NOT ASSUME THE RESPONSIBILITY OR OBLIGATION FOR ANY MEDICAL BILLS OR DEBTS RESULTING FROM ANY INJURY TO THE ABOVE NAMED CAMPER WHILE PARTICIPATING IN ANY CAMP ACTIVITIES.

I hereby authorize the staff of the Maranatha Summer Camp located in Watertown, Wisconsin, to consent to any X-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care necessitated by injury or illness, while the above-named child is attending the Maranatha Summer Camp. Such treatment is to be rendered to the camper under the general or special supervision or the advice of a physician or surgeon licensed to practice in the State of Wisconsin.

I hereby waive and release the camp from any and all liability.

I hereby affirm that my child has no physical conditions, which will limit participation in the full range of activities being planned.

Parent/Guardian indicates agreement with above statement electronically by typing their full name here

Immunization Information

Camper Has Been Immunized

Date of Last Tetanus Shot

Date of MMR Injections

This section is a request to exercise my right to waive immunization requirements for my son/daughter,

(son/daughter's name)

This request is made based on my personal and philosophical beliefs.

I agree to hold harmless Maranatha Baptist University and Maranatha Camps in the event of any possible illness or injury resulting from waiving my immunization requirement. I also understand that in the event of a suspected case of measles, it would be necessary for my child to leave camp at that time.

Parent/Guardian indicates agreement with above statement electronically by typing their full name here

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Phone Number

Cell phone number is preferred

Does your child have any special needs/disability that would require special accommodations?

Please Explain:

Note: We will review the information provided in light of staff availability and campus capacity and contact you for further information and/or to confirm our ability and proposed strategy to meet your child’s needs. Parents are responsible to provide special equipment and/or personal assistance needed to accommodate transportation and basic living arrangements.

Final Details

Releases and Acknowledgments

I give my permission to use photo and video images of the camper in MBU publications (if you have extenuating circumstances requiring an exception, please email Katie.Potter@mbu.edu)I acknowledge that as a participant in one of the following tracks (musical drama, piano, strings, band [just those participating in chamber groups]), I am required to also turn in an audition form by May 1

Completed Releases and Acknowledgments?

How did you first learn about Music and Drama Camp?

Other Explanation

Pricing Information

HIDDEN - Registration Fee

HIDDEN - Early Registration Cutoff

HIDDEN - Is Before Early Cutoff?

HIDDEN - Camp Fee

Registration Fee Amount

Camp Fee Amount

Your camp fee includes an Early Bird discount because you're registering by April 10!

Discounts and Scholarships

Please list the source and amount of any scholarships or special discounts you are receiving (other than the Early Bird discounts).

If a church, music club, etc. is paying instead of you, please include that here.
Maranatha Fac/Staff Discount: Children of current full time MBU faculty/staff will receive discounts of $100 (full teen camp), $75 (day camp), $50 (morning camp) per child.
New Attendee Scholarship: Pending based on application and video. Scholarship amount to be applied later. Please pay the $35 non-refundable registration fee now.

Source

Amount

Discounted Camp Fee Amount

Are you paying only for registration now?

YesNo, I would like to make the full camp tuition payment now

Please note: Registrations will not be processed until the registration fee is paid. The registration fee is applied towards the overall tuition cost.

HIDDEN - Calculated Total

HIDDEN - Total > $0?

Total Payment Amount Now

(Remaining Balance)

Payment Information

Customer Details

First Name

Last Name

Organization Name

Email Address

Phone Number

Billing Address

Street

City

State

Zip

Country

Payment Method

Credit CardeCheck (USA Only)

Credit Card Details

Name on Card

Card Number

CVV

Expiration Month

Expiration Year

NOTE: You have chosen a non-USA billing address and the eCheck payment method. Your eCheck payment will not be able to be processed from a non-USA bank account.

Bank Account Details

Account Holder Name

Bank Name

Account Type

Account Number

Routing Number

Confirm Account Number

Confirm Routing Number

Account Numbers Match?

Routing Numbers Match?

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