Student Name __________________________________________
Telephone:______________________________________
Address:_______________________________________________
School: _______________________________________
Age:_____ Grade:_____ Instrument:_________________________
Music Teacher:____________________ Phone: _________________
Music Teacher Email: _________________
Parent / Guardian name: ______________________________
Address:__________________________________________
Phone: ___________________ Email: _____________________
Be sure to select which week and location you want to attend.
(if you have special dietary needs, you must bring your own lunch)
Week #1: ______
Week #1 location: Colin Powell Youth Leadership Center
2924 4th Ave. So., Minneapolis, MN 55408
Date: Monday - Friday, June 14-18, 2010
Time: 9:00 a.m. - 3:00 p.m. each day. Lunch will be provided
Week #2: ______
Week #2 location: F.A.I.R. School
3915 Adair Avenue North, Crystal, MN
Date: Monday - Friday, June 21-25, 2010
Time: 9:00 a.m. - 3:00 p.m. each day. Lunch will be provided
www.colinpowellcenter.org (612) 638-1000
- A donation of $160 for the week long camp is suggested.
Full and partial sponsorships are available.
No student will be turned away for lack of funds.
If you have questions, please call Bernie Edstrom at 763-542-8880.
- If you wish to help another student who can't afford the $160 donation,
it would be greatly appreciated. No student will be denied because of lack
of funds, however we only have 85 students who can attend each week.
The camp is one week long. We hope you can help.
Mail your application to: (print or copy the information on this page)
Bernie Edstrom
10545 33rd Avenue North
Plymouth, MN 55441
763-542-8880 BEdstrom@bitstream.net www.tcyjazzcamp.com