Summer Music Camp Registration 2026

Camper Name *

First

Last

Camper Pronouns *

Attach a recent photo of your camper *

Click or drag a file to this area to upload.

Camper Birthdate (MM/DD/YYYY) *

T-Shirt Size

LIT pick-up to

How did you hear about Summer Music Camp? *

Parent/Guardian and Emergency Contact Information

Parent/Guardian Name *

First

Last

Parent/Guardian Email *

Parent/Guardian Phone *

Parent/Guardian Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Authorized for pick-up from camp? *

Yes
No

Add a: *

Parent/Guardian 2 Name *

First

Last

Parent/Guardian 2 Phone *

Parent/Guardian 2 Email *

Parent/Guardian 2 Address

Same as parent/guardian 1
Different from parent/guardian 1

Authorized for pick-up from camp? *

Yes
No

Parent/Guardian 2 Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Emergency Contact *

First

Last

Other than parent/guardian listed above

Relationship to Camper *

Emergency Contact Phone *

Authorized for pick-up from camp? *

Yes
No

Add a:

Emergency Contact *

First

Last

Other than parent/guardian/emergency contact listed above.

Relationship to Camper *

Emergency Contact Phone *

Authorized for pick-up from camp? *

Yes
No

Additional Camper Information

Program Selection *

What kind of musical experience does your child have? (i.e., playing instruments, singing, how long?) *

Why do you want to be a part of the LIT program? *

Please have youth complete this section.

Camper's Address *

Same as parent/guardian 1 and 2
Same as parent/guardian 1
Same as parent/guardian 2

Are you in need of early drop off or late pick up? *

Early drop off between 8:30am-9:00am
Late pick up between4:00pm-4:30pm
Both Late Drop off and Early Pick Up
Regular camp hours

Does your camper have any allergies, dietary restrictions, medical conditions, special support needs, Please specify. *

Is there anything else we should know about your camper? *

We would appreciate any information that would be helpful to us while your child/youth is in our care.

By checking this box, I give permission for my child/youth to participate at Summer Music Camp, including offsite (fieldtrips, playground, etc.) and I release Islington United Church, staff, and volunteers from liability in the event of an accident or injury. *

Yes, I consent

By checking this box, I give permission for Islington United Church to photograph, video or audio record my child/youth and use any resulting media in communications, on the website, or in social media postings. *

Yes, I consent
I would not like my child’s photo posted online

Payment

Payment *

Early Bird Fee ($500 before May 1)
Sibling Discount ($425 each if registering a sibling)
Non-Refundable Deposit ($75)
Leader In Training Program ($100)
Contact me about financial aid

Total

$0.00

Payment Method *

E-transfer
Credit Card

Credit Card *

Card

Name on Card

E-transfer

After submitting this form, please complete the e-transfer through your bank to give@islingtonunited.org. Please specify “Summer Music Camp” in the memo field. Your spot will only be reserved once payment is received.

Summer Music Camp Registration 2026

Parent/Guardian and Emergency Contact Information

Additional Camper Information

Payment

E-transfer

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Summer Music Camp Registration 2026

Parent/Guardian and Emergency Contact Information

Additional Camper Information

Payment

E-transfer

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