Wickenburg Children’s cultural Organization (WCO)

  Orchestral Music Workshops

July 6 – July 10, 2015

Venue: Wickenburg High School

 245 N Tegner St, Wickenburg, AZ 85390

 (928) 684–7473

  music@wco.org

Registration Form

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Child’s Name____________________________      Age_____    T-Shirt Size_________

                                                                                                                                                                              (Child/Adult S,M,L,XL)

Parent’s Name____________________________     Email_________________________

Mailing Address__________________________________________________________

Phone/Home_____________________________     Cell/Work_____________________ 

Registration Fees:  Music Explorers $45, Young Performers $75/session

*Limited scholarships are available depending on need.  Forms may be picked up at the LRSH

Tues-Sat 10-2.

Please select the workshop you are interested in.

□    Music Explorers Workshop – M-Th. 9:00a–12:30p, Fri. 9:00a–5:00p

                Registration Fee:  $45

This workshop is designed for students ages 7 and older with little or no musical background or experience.

Students will be introduced to the orchestra instruments through demonstrations and hands-on experiences including: keyboarding, singing, rhythm activities, and instrument construction.  Students will also enjoy presentations by local musicians. 

□    Young Performers Workshop – M-Th. 9:00a–12:30p, Fri. 9:00a–5:00

               Registration Fee:  $75 per session

   Section 1:  Violin                        Section 2:  Piano                          Section 3:   Guitar & Ukulele

Section 4: Band*                        Section 5:  Voice                                            (must have own)

            Instrument: _________________

            *Possible additional instrument rental fee based on availability of instruments.

The Young Performers Workshop is designed for students age 7 and up who are interested in an intense hands-on experience with an instrument or voice.  No experience is necessary.  Some instruments for the camp experience will be provided by the WCO.

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Wickenburg Children’s cultural Organization

Orchestral Music Workshops

Medical Information and Release Form

Please Print Clearly

Medications currently being taken______________________________________________________________

*Please Note: Staff will not be able to administer medicine to children or hold medicine for them.

Allergies or reactions________________________________________________________________________

Restricted activities for this child_______________________________________________________________

Other comments____________________________________________________________________________

As parents/guardians of (Print Child’s Name)_____________________________________, we hereby consent, in our absence, to any adult in possession of this Medical & Release Form consenting to, authorizing or approving any X-ray examination, anesthetic, medical, dental or surgical diagnosis or treatment and emergency and hospital care to be rendered to our child under the general or special supervision and on the advice of any licensed physician, dentist, surgeon, nurse of paramedical person, and we agree to pay for such treatment.  We also agree to indemnify and hold harmless such person who may be in possession of this Medical & Release Form, WCO and their boards, committees, officers, agents, and employees, including but not limited to the supervisors, counselors and director of the Wickenburg Children’s cultural Organization Orchestral Music Workshop and any qualified medical person from any and all claims, demands, suits or judgments or actions of any kind arising out of our child’s participation in the program.  Also we release any and all medical persons, institutions and organizations from reliance upon the consent authorization of approval of medical treatment for our child made by an adult in possession of this Medical & Release Form.

Parent or Guardian Signature___________________________________     Date_________________________

Participant’s Name (Please Print) _______________________________      Home Phone___________________

Please identify the person(s) who will be picking your child up at the end of each session

 ________________________________________________________________________________________

Wickenburg Children’s cultural Organization

Photography Release

I hereby grant to the Wickenburg Children’s cultural Organization and to its employees, agents and assigns, the right to photograph and use the photo and or other digital reproduction of him/her or other reproduction of his/her likeness for publication processes, whether electronic, print or electronic publishing via the internet.

Child’s Printed Name: __________________________________________________________________

I certify that I am the parent of guardian and have the aforementioned rights to assign.

Signature of Parent of Guardian: __________________________________________________________

Date: ______________________________

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