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Participant First Name
Participant Last Name
First and last names
Number, Street, City, State, Zip
My private teacher is...
Redding Farlow Soderberg
I do not have a private teacher.
Suzuki Book Level
Pre-twinkle (up to and including Twinkle)
Book 1 (Lightly Row and beyond)
Book 5 and beyond
Current Polished Piece
I understand that all children under age 16 must be accompanied by an adult.
I allow any photos or videos of my child taken at the event to be used, nameless, by the organizers in publications or news media.
I understand that I, as a parent of a child participating in the Fiddle Workshop & Family Barn Dance February 23 & 24, 2018 at (location), am fully responsible for my child's safety and well being. I will not hold Lorraine Westermark, Jessica Landes, clinicians, or (location) liable for any injuries or damages during this two-day event.
Checking this box is the equivalent of a signature and affirms the above statement.
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