Harp Fantasia 2019 Registration Form
September 28th, 2019
At the Lakewood Cultural Art Center
470 S Allison Pkwy, Lakewood, CO 80226
Contact Information:
(If participant is a minor under 18 years old please fill out both the parental information as well as the participant information)
Participant Name *
Your answer
Participant Parent Name(s):
Your answer
Participant Age: *
Participant Email: *
Your answer
Participant Parental Email:
Your answer
Participant Phone Number: *
Your answer
Participant Parental Phone Number(s)
Your answer
Emergency Contact Information: Please list emergency contact name, phone number, and relationship to participant *
Your answer
Please inform us of any known list any known medical conditions (allergies, asthma, medications...) that would warrant our attention:
Your answer
Medical Release: I the participant or parent and/or legal guardian of minor (under 18 years old), hereby give consent to the adults in charge of the Harp Fantasia program to secure medical treatment for myself or my child in the event that the named emergency contact (listed on this form) cannot be reached and that I am responsible for any and all costs associated with the transportation and medical treatment. I agree to pay for any charges for emergency medial treatment that are not covered by my personal health insurance. I also certify that if I (the participant) or my child has any special medical considerations, including food or other allergies, I have communicated those in the registration form above. *
Required
Participant Information
Years of Harp Study *
Your answer
I Play a *
Current Teacher Name, Email, and Phone Number
Your answer
I would like to be a part of harp ensemble group: *
Required
Shirt Size *
Shirt Color *
I understand that I must be a member of the Mile High Chapter of the American Harp Society to participate in this event and I will pay the dues (if not already a member) and registration fee online by the Brown Paper Tickets Link or pay in person at Kolacny Music in Denver (No registration refunds will be granted after August 1st, 2019) *
Required
I give my permission for pictures taken at the event to be displayed on the Mile High Chapter Website, Mile High Social Media, or for future marketing through the AHS. *
Required
Optional Small Group Performance Information
We are excited to include the addition of small ensemble group performances to the final Fantasia Concert
(There are a limited number of spaces available and the mile high board will review and approve your performance request. You may be asked to provide a short audition sample of your musical selection)
Small Ensemble Primary Contact Leader Name:
Your answer
Small Ensemble Primary Contact Phone Number:
Your answer
Small Ensemble Primary Contact Email Address:
Your answer
Song Selection Title and Composer: (Total performance time limited to no longer than 4 minutes)
Your answer
Song Selection Length:
Your answer
Small Group Member Names and Instruments:
Your answer
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