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Registration and Payment

One Day Camp Cost is $65 per person.
(Register 5 - Get One Free! Call 609-937-4117 to register groups of 6 or more)

Remember to fill out the registration form below and to send in your payment to reserve your spot. Registration is guaranteed upon receipt of payment.
($25 charge for returned checks)

Please make checks out and mail to:
DTM MUSIC, Inc.
217 Peach Road
Edgewater Park, NJ 08010

L.E.A.D. Registration 2011

Please fill in the following REGISTRATION INFORMATION as completely as possible: Email any questions to: leadcamps@comcast.net or you can call 609-937-4117 and speak to David May - Director of L.E.A.D. Camps.

First Name:
Last Name:
Address Street 1:
Address Street 2:
City:
Zip Code:	(5 digits)
State:
Daytime Phone:
Evening Phone:
Email:
Date of Birth:
T-Shirt Size (S-3XL):
Grade Level:
Coach/Teacher/Director:
Your Position or Title:
Parent/Guardian First Name:
Parent/Guardian Last Name:
Address Street 1:
Address Street 2:
City:
Zip Code:	(5 digits)
State:
Phone / Cell Phone:
Emergency Contact First Name:
Emergency Contact Last Name:
Emergency Phone:
Physicians Name:
Physicians Phone:
Hospital Affiliation/Preference:
Daily Medications:
Medical Allergies:
Food Allergies:
Other Allergies:
Chronic Medical Conditions:
Medical Insurance/ HMO #:
Any other comments or notes: