Custom Scholarship Registration Page #1

Registration Form - Piano Camp and Creativitity Camp (Coulter)

HOW MANY CHILDREN (SIBLINGS)?

How many children (siblings) are you registering for the July 2023 camp(s)? (Sibling Discount Available).

CAMP SELECTION

Child's First Name

Child's Last Name

Child's Age

Which Camp(s) Will Your Child Attend?

Piano Camp Only: $25 (Scholarship Deposit)

My child meets the eligibility requirements for the Piano Camp (see above for details)

Do you have your own piano keyboard that you would be willing to let your child bring to the camp? (It would be stored securely)

Yes

Child #1 First Name

Child #1 Last Name

Child #1 Age

Which Camp(s) Will Child #1 Attend?

Piano Camp Only: $25 (Scholarship Deposit)

Child #1 meets the eligibility requirements for the Piano Camp (see above for details)

Do you have your own piano keyboard that you would be willing to let your child bring to the camp? (It would be stored securely)

Yes

Child #2 First Name

Child #2 Last Name

Child #2 Age

Which Camp(s) Will Child #2 Attend?

Piano Camp Only: $25 (Scholarship Deposit)

Child #2 meets the eligibility requirements for the Piano Camp (see above for details)

Do you have your own piano keyboard that you would be willing to let your child bring to the camp? (It would be stored securely)

Yes

Child #3 First Name

Child #3 Last Name

Child #3 Age

Which Camp(s) Will Child #3 Attend?

Piano Camp Only: $25 (Scholarship Deposit)

Child #3 meets the eligibility requirements for the Piano Camp (see above for details)

Do you have your own piano keyboard that you would be willing to let your child bring to the camp? (It would be stored securely)

Yes

PARENT/GUARDIAN INFORMATION

Parent/Guardian's First Name

Parent/Guarian's Last Name

Email Address

Phone/Mobile

Do you need to provide information about allergies or medications for your child?

Yes

Please Describe Relevant Information About Your Child's Allergies or Required Medications

EMERGENCY CONTACT INFORMATION

Emergency Contact for the camp is the same as the Parent/Guardian listed above

I need to enter a separate Emergency Contact

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Phone Number

ADDITIONAL AGREEMENTS

Photos and/or videos of the camp may be recorded to share the experience with long-distance friends and family as well as for promotional purposes

Check this box if you do NOT permit photos/videos of your child to be published

I acknowledge that I have read and agree to the Ridgway Creative Arts Camp Agreement and Release of Liability.

Please select a camp above to see your payment summary

Scholarship Registration Form

Note – This is a custom form requiring pre-approval for scholarship. Please reach out to Katy with questions.

HOW MANY CHILDREN (SIBLINGS)?

CAMP SELECTION

PARENT/GUARDIAN INFORMATION

EMERGENCY CONTACT INFORMATION

ADDITIONAL AGREEMENTS