Basstravaganza 2020 Registration
Cost: $375 per session
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Session Wishing To Register For: *
Student Name
Student Age
School Name *
Grade Completed
Private Teacher
Years Experience
Did you learn a piece for Solo and Ensemble?
Clear selection
If "Yes," what piece did you play?
T-Shirt Size
Clear selection
Mother/Father/Guardian Name
Home Phone #
Day Time Phone #
Parent/Guardian Email
Address
Medical Release
Name of Minor
Date of Birth
Emergency Contact #1
Emergency Contact #1 Phone
Emergency Contact #2
Emergency Contact #2 Phone
Insurance Company
Policy #
Doctor Name
Doctor Phone #
List any pertinent medical history or information: (allergies, medication, etc.)
While the leadership of the Basstravaganza will take every ordinary precaution for the safety of each participant, it is understood that the participation in the activities is at his/her own risk. In the event that I am unable to be reached, in the case of injury or illness, I
(mother/ father/guardian)
hereby give permission for treatment as deemed necessary by the staff. I also release Basstravaganza and its leaders and the Church of the Good Shepherd of liability in case of injury incurred by my child,
Media Release
I,
(Parent/Guardian)
give permission for my child
to appear in promotional material for Basstravanganza summer camp. A video/picture of their performance in the July 2020 concert may be used to promote the camp in 2020 and beyond. Prior screening of this material will be available upon request.
Date
Submit
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