About Camp Time and Location Fee and Registration Housing and Meals Activities Sample Schedule
About the Camp Director About the Guest Director About the Camp Hosts About the Sponsors Online Application More Information

 

Please fill in all fields, print, and return to:

Music On The River

P.O. Box 131

Manakin Sabot, Va 23103

 

Last Name

First Name

Home Address

City

State

Zip Code

School Next Fall

Grade Next Fall

Instrument

Gender

T-Shirt Size (Adult Sizes Only)

 

Health Information:

In case of an emergency, I understand that I will be contacted immediately. If I am unavailable, please contact:

Contact Person

Phone Number

Family Doctor

Doctor's Phone Number

 

Payment Information:

Payment Schedule:

$50.00 Non-Refundable Deposit (Due by April 18)

Full Camp Fee of $300.00 is due by June 3 - ($325.00 if paid after June 3.)

A camp "Memories DVD" is available for sale for $20.00. Would you like to purchase a Camp DVD?
Please add $20.00 to your total if you are purchasing a camp DVD.

Total Amount Paid
Please see below for payment information.

 

If paying by cash, money order, or check please make payable to MUSIC ON THE RIVER and enclose the required amount in an envelope and send to:

Music On The River

P.O. Box 131

Manakin Sabot, VA 23103

 

Credit Card Payment Information

*A $3.00 processing fee is added if paying by credit card.

Credit Card

Credit Card Number

CCV Code (last 3 digits on back of card)

Expiration Date : Month Year

Name On Card