Student’s Name _______________________________ Age: _______

Grade (2020-21 school year): ____ Gender: (circle) Male Female Non-Binary ______

Address ____________________City__________ State ____ Zip_______

Student’s Phone (____)______________ Email: ____________________

Parent/Guardian Information:

Parent/Guardian (name) _____________________________________

Cell Phone (_____)______________ Email: _____________________

Student's Musical Background:

How long has the student been playing? ___ (circle one) Yrs. Mos.

Name of the school where student began musical studies:_____________

Who is the student’s medical insurance provider?__________________

Snacks are provided at camp. Does your child have any allergies? y or n

If yes, please specify: _______________________________________

Important: There will be a hired media team on site capturing footage and images for promotional purposes. Does Kingdom Flute Works have your permission to use your child's image for advertising purposes? If you do not wish for your child's image to be captured please be sure to circle noand if we have your permission please circle yes.Please circle one of the following: yes or no

Scholarship Applicants:

Scholarship essays MUST:

1. Be written by the student applicant

2. Be submitted with the student's application