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SummerFest Music Workshop Registration

Please fill out the following form to complete registration for the Off The Hook Arts SummerFest Music and Arts Workshop. Payments, including the non-refundable registration fee of $15, can be made online via PayPal or by check by mail to: Off the Hook Arts 1001-A East Harmony Rd. #260 Fort Collins, CO 80525. Registration deadline: June 8! NO refunds for cancellations after June 8th.

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Student Information
Student Name*
First Last
Program you're applying for:*
What instrument do you play?
- Violin
- Viola
- Cello
- Guitar
Student Age*
Please enter a number from 5 to 18.
Current Teacher
School Attending (In Fall)
Grade (In Fall)
Piece You are Currently Studying
If you are a Music Explorer this question does not apply
Student Level*
T-Shirt Size*

Emergency Contact Information:
Parent Name*
First Last
Parent Name
First Last
Parent Phone*
Second Phone
Parent Email*
Second Email
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Medical Information
Primary Doctor*
Doctor's Phone*
Does your child have any food allergies or special needs that we should be aware of?
I certify that this form is for my child.*
- Yes, I grant permission to treat my child in an emergency
- No, contact me prior to treating my child
Parent Electronic Signature*
If you don't have access to electronic signature, type your name in the box.
Insurance Information
Insurance Carrier*
Insurance Company Phone
Policy Holder's Name*
Policy Number*
Group Number

In submitting this form, I agree to allow pictures and video of my child to be used for marketing/website purposes.*
- Yes
- No
How did you learn about this program?*
If Media/Press Release
Registration and Payment
Workshop Program*
Scholarships available. Please email director@offthehookarts.org with questions.
- Music Explorers $175
- String Players $175
- Advanced Seminar $175
- Beginning Guitar Class $175
Would you like to cover the credit card fees for this transaction so that all of your funds go toward supporting our non-profit programs?
Price: $5.00 Quantity:
Total
$0.00
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Email Address

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Off the Hook Arts

1001-A E Harmony Road #260
Fort Collins, CO 80525
970-305-2261
director@offthehookarts.org

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