Camp Festival Amadeus Application Registration is now open for August 6-11, 2017 for Grades 7-12! Order Number PERSONAL INFORMATION Name * Email * Parent/Guardian Birth Date Gender Male Female Address * City * State * - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip * Home Phone Alt. Phone * Emergency Contact * Emergency Contact Phone * Any health issues/dietary restrictions? T-Shirt Adult Size (select one) * S M L XL School Grade in fall (select one) 7 8 9 10 11 12 Instrument (select all that apply) violin viola cello bass flute clarinet piano Any other instrument? School music teacher Phone Email Years played Do you take lessons privately? Yes No Private Teacher Phone Current Working Piece Title Composer PLACEMENT AUDITION (for first year students without teacher referral) Audition media CD mailed Audition in person Bozeman Whitefish YouTube link provided YouTube URL Link Title of Piece Composer HOUSING ($75.00 additional fee) Housing required? Yes No Name of host family/student you wish to stay with (if known) FEES AND PAYMENT $375 postmarked by June 1st $400 postmarked by July 1st $425 postmarked after July 1st and subject to space availability $75 housing fee for week, if required $25 per 30 minute private lesson $100.00 deposit due upon application; the remainder is due by July 15th: No. of Private lessons: Faculty name (office use only) MEDICAL RELEASE/INTERNET PHOTO AUTHORIZATION By submitting this application, I hereby authorize North Valley Music School, Glacier Symphony and Chorale and their staff, faculty, and guest artists as agents of the undersigned to obtain any necessary medical care for my child and consent to medical treatment in event of an emergency during the Camp Festival Amadeus, August 6 through August 11, 2017. I also authorize any licensed medical personnel to give any necessary treatment to my child. I assign NVMS and GS&C all rights to any photos taken during the CFA and authorized same to utilize pictures of my child on their respective websites, brochures, or other media. I also hereby release and discharge NVMS and/or GS&C and their staff, faculty and guest artists for any and all claims for personal injury. I assign NVMS all rights to any photos taken while participating in the activities described above and authorize NVMS to utilize pictures of myself and/or my child on the web or in any other media. Please do not use photos of myself and/or my child on the web or in any other media. PRINT FORMIf you would prefer, please print this form and drop off or mail form and check made payable to NVMS to: North Valley Music School PO Box 4446, Whitefish, MT 59937 Registration and $25 deposit due 2 weeks prior to class. Full payment due by the first day of class.Payments and deposits are fully refundable up to 2 weeks before the start of class.