Band Camp Registration

Personal Info

Name*

First Middle Last Suffix

Preferred First Name

or nickname, if different from above.

ECU Banner ID Number*

ECU Email Address*

Use ONLY your email address ending with @students.ecu.edu. Account Information

Enter Email Confirm Email

Birthdate*

Age*

at the beginning of band camp.

Home/Permanent Phone Number*

Student's Cell Phone Number*

Parent/Guardian Email*

Home/Permanent Mailing Address*

Street Address Address Line 2 City State ZIP Code

Medical History*

Please list all medical conditions and major surgeries.

Allergies and any Special Dietary Needs/Restrictions:*

Are you a vegetarian or vegan?*

No
Yes, Vegetarian
Yes, Vegan

Current Medications*

Please list dosage and frequency.

Emergency Contact

Emergency Contact Name*

First Last

Relationship*

Emergency Contact Phone Number*

Alternate Phone Number*

Insurance Information

Company Name*

Policy Number*

Other Info

What is your academic designation at ECU?*

Is this your first year in the Marching Pirates?*

Yes
No

Graduated/Transferred From What School?*

For new students only... all others may put NA.

Former Band Director's Name

if applicable

Former Band Director's Email

How many years have you been a member? (Including this year)*

2
3
4
5

Intended Major*

What is your current GPA?*

List any clubs of which you are a part.*

including fraternities, sororities, religious/spiritual clubs, academic clubs, cultural clubs, etc.

Why do you want to be part of the Marching Pirates?*

Check all that apply.

I wanted to continue my music/marching at college.
Previous family members in band.
Scholarship/stipend opportunity
Friendships
High Profile Performance Opportunities
Something New
Become Involved on Campus
Other

If other, please explain.*

Instrument/Performance Area*

Do you own your own marching instrument?*

Yes
No
NA (for guard, dance, drumline, drum major, twirler, sousaphone)

Additional Comments/Questions

Agreement

By completing and submitting this form, I:

Agree to being a member of the ECU Marching Pirates for the 2023 season. Submitting this form shows that I understand that I must fully attend Preseason Band Camp and complete an audition in order to earn a spot within the band.
Agree that in the event that I am rendered unable to communicate due to illness, accident or emergency while participating in activities of the ECU Marching Pirates, I hereby give permission to a Physician selected by the ECU Marching Pirates staff to hospitalize, secure proper treatment for and to take whatever medical actions are necessary to treat me. I further authorize payment for treatment either by me personally or through my medical health insurance provider.
Agree that I have read, understand and will abide by the expectations, policies and guidelines for all members of the ECU Marching Pirates for the 2023-2024 academic year.

Please read the above carefully before checking this box.*

I AGREE

Name

This field is for validation purposes and should be left unchanged.

Personal Info

Emergency Contact

Insurance Information

Other Info

Agreement

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