HOMELANI MUSIC & GOSPEL ARTS CAMP 2017 Friday June 23 – Saturday July 1

STUDENT APPLICATION FORM

(Due NO LATER THAN Friday June 2, 2017)

NAME: _____________________________________________ M/F: _______ BIRTHDATE: ___________

ADDRESS: _____________________________________________________________________________

SCHOOL: _________________________________________________________ GRADE: __________

EMAIL ADDRESS: _______________________________________________________________________

*ParticipantssignedupfortheseclassesMUSTbringtheirowninstrument(‘Ukulele/Guitar/BassGuitar/Brass/Timbrel)

I understand that this application is due by June 2nd. Upon acceptance, I will receive a packet of additional forms. I will receive a special rate so that my fee for Homelani Music & Gospel Arts Camp 2017 is $215. This

fee, along with all necessary health and permission forms are due no later than June 16th. I will be responsible to bring my own instrument to camp. I know that Camp Homelani is a Christian Camp run by

The Salvation Army, and that I must attend daily bible classes and behave in a respectable manner.

STUDENT SIGNATURE: _________________________________________________________________

PARENT SIGNATURE: _________________________________________________________________ P.O. BOX 620 � Honolulu, Hawaii 96809-0620 � Tel: 808.440.1852 � Fax: 808.440.1952

CORPS USE ONLY Corps:

Active Soldier: (circle one)

Junior Senior

CAMP USE ONLY o Theory Test o Major Audition

T-SHIRT SIZE (circle one):

Youth Small

Youth Medium

Youth Large

Adult Small

Adult Medium

Adult Large

Adult X-Large

Adult XX-

Large

Adult XXXLarge

MAJORSThefollowingMajorswillbeoffered.

PleasecircleONEMajoryouwouldliketoparticipatein.

KEYBOARD/PIANOHowlonghaveyoubeenplaying?(Ifbeginner,write0)________________

HULABringyourownpāʻūskirtandaplainblackblouse.

ʻUKULELE*

ACOUSTICGUITAR*/ELECTRICGUITAR*(circleone)

BASSGUITAR*/DRUMS(circleone)

ELECTIVESPleaseranktheelectivesyouwouldliketo

participatein.(1through6)(Electivesofferedaresubjecttochange)

1–firstchoice,2–secondchoice,3–thirdchoice,etc…Brass*________

Boys’Chorus________

ModernDance________

Drama________

VisualArt________

Timbrel*________

(pleasecompleteconsentformonback)

SOLOISTNIGHTo IwouldliketocompeteinSoloistNightandwillprepareasolopriortocomingtocamp.

(pickacategory)

___Vocal ___Instrumental(Brass/Piano/Guitar/Ukulele) ___CreativeArts(Hula/Drama/Timbrel/Sign/Dance)

The Salvation Army Homelani Music & Gospel Arts Camp 2017

Parental Release Form

Participant Info

Name: _____________________________________________________________

Phone: (_______) _____________________________________

Parents’ Info

Name(s): _______________________________________________ Phone (_____) _________________

Parents’ Email: ________________________________________________________________________

Other Emergency Contact

Name: _____________________________________________ Relation: _________________________

Phone Number: _______________________________________

The undersigned, being the person having legal custody of the above individual who is a minor, hereby authorize The Salvation Army, Hawaiian and Pacific Islands Divisional Headquarters, acting through any adult personnel thereof, into whose care said minor has been entrusted, do consent to any X-ray, examinations, anesthetics, medical, or surgical diagnosis, or treatment and hospital care to be rendered to said minor under the general or special supervision and upon advise of a physician and surgeon licensed under the provision of the State Medical Practice Act or to consent to an x-ray, examination, anesthetics, dental or surgical diagnosis or treatment and hospital care to be rendered to said minor by dentist licensed under the provision of the State Dental Practice Act.

Activity Release As part of the week, campers will have the opportunity to participate in a final concert at The Salvation Army Kroc Center on Friday June 30, 2017.

By signing the following agreement, either as the parent/legal guardian of minor, or as an adult aged 18 and above, I acknowledge that the potential risks that may be associated with my (my child’s) participation in The Salvation Army’s Music & Gospel Arts Camp have been explained to me. Furthermore, I represent and confirm that to the best of my knowledge, I (my child) suffer from no permanent or temporary physical or mental disability or impairment that requires any special attention, auxiliary aids or services except as set out herein (please be specific):

_____________________________________________________________________________________________

I agree to the conditions, regulations and policies of The Salvation Army’s Music & Gospel Arts Camp and

accept full financial and legal responsibility for my own (my child’s) conduct. Additionally, I authorize the Administrators of this program to provide reasonable and necessary emergency medical treatment should it become necessary during my (my child’s) participation in this program.

I agree to relieve The Salvation Army, it’s directors, officers, employees, volunteers, agents, or other representatives from any and all liability in connection with any loss, damage, or injury arising from my (my child’s) participation in these programs.

I acknowledge that I have carefully read this document, that I know and understand it’s content, and that I sign this document by my own free will.

Participant’s Signature:______________________________________________ Date: ____________________

Parent’s Signature:__________________________________________________ Date: ____________________

HOMELANI MUSIC & GOSPEL ARTS CAMP 2017 Friday June 23 – Saturday July 1

APPLICATION INSTRUCTIONS 1. Complete both sides of the application.

2. No later than June 2nd, submit your application via:

Email: sarah.sloan@usw.salvationarmy.org Fax: 440-1932 Mail: P.O. Box 620

Honolulu, Hawaii 96809-0620

3. Upon receipt of your application, we will send you additional health and permission

forms to complete.

4. Mail all remaining forms AND $215 fee (check made payable to The Salvation Army)

to the above address no later than June 16th.

IMPORTANT DATES TO REMEMBER Friday June 2nd, 2017 Application due

Friday June 16th, 2017 Additional health & permission forms due

Friday June 23rd, 2017 First Day of Camp! 2:00pm Registration Begins @ Camp Homelani

Wednesday June 28th, 2017 Soloist Night Families Welcome! 7:45pm-9:00pm @ Camp Homelani

Friday June 30th, 2017 Final Concert Families Welcome! 7:00pm @ The Salvation Army Kroc Center

Saturday July 1st, 2017 Last Day of Camp! 9:00am Pick up @ Camp Homelani

Questions? Comments? Concerns? Contact Crystal Nakamaejo at:

crystal.nakamaejo@usw.salvationarmy.org � (808) 440-1852