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SUMMER MUSIC EXPERIENCE JUNE 22-‐26, 2015 from 9 am – 5 pm | OLD TRAIL SCHOOL 2315 Ira Road in Bath String chamber ensemble and vocal/choral coaching and performance for adult and student musicians in the glorious setting of the Cuyahoga Valley National Park. APPLICATION FORM Participant Name_____________________________________________________________________ Preferred Name/Nickname ______________________________________________________________ Street Address ________________________________________________________________________ City/State/Zip _________________________________________________________________________ Home Phone _________________________ Cell Phone ______________________________ E-‐mail Address ________________________________________________________________________ Birth Date ___/___/_____ Gender (circle) M / F Grade Fall 2015 (student) __________ Parent(s)/Guardian(s) Name (for minors) ___________________________________________________ Parent(s)/Guardian(s) Address (if different from above) _______________________________________ Parent(s)/Guardian(s) E-‐mail ____________________________________________________________ Home Phone __________________ Parent Day Phone (if not home #) ________________________ Cell Phone (designate whose #) ___________________________________________________________ For which track are you applying? (Check ONE and continue with the corresponding application.) Youth Vocal/Choral Adult String Chamber Ensemble Adult Vocal /Choral Student String Chamber Ensemble STUDENT STRING CHAMBER ENSEMBLE Participant Name_____________________________________________________________________ Primary Instrument__________________________ Years of experience on your instrument__________ School (Fall ’15)_______________________ Ensemble Director ________________________________ Do you take private lessons? (circle one) Y/N If yes, how long? _________________ Instructor’s name _____________________________________________________________________ Person providing recommendation ________________________________________________________ Have you played in a chamber ensemble before? (circle one) Y/N If so, please state where and how long ____________________________________________________ List previous chamber repertoire_________________________________________________________ ____________________________________________________________________________________ FEES COST AMOUNT DUE $345 -‐-‐-‐-‐-‐ $50 $20 $30 $ 7 $13 ________ ________ ________ ________ ________ ________ ________ ________ ________ Student Tuition (grades 7-‐12) Includes steel drumming Fencing (optional) Lunch (optional -‐ $20 per week) Late registration fee (after June 5) T-‐shirt (Note Size _____________) Polo shirt (Note Size ___________) TOTAL FEES DUE Less Deposit Amount Paid (at least $50) BALANCE DUE MUST be paid by June 5, 2015 PAYMENT METHOD ____Check enclosed ____Credit Card Information MC Visa Discover American Express Account # _______________________________________________________ Expiration Date _______ Code _______ For Office Use Only: ADDITIONAL PAYMENTS DATE AMOUNT PAYMENT METHOD ADULT STRING CHAMBER ENSEMBLE Participant Name_____________________________________________________________________ Primary Instrument__________________________ Years of experience on your instrument__________ Do you take private lessons? (circle one) Y/N If yes, how long? _________________ Instructor’s name _____________________________________________________________________ Person providing recommendation ________________________________________________________ Have you played in a chamber ensemble before? (circle one) Y/N If so, please state where and how long ____________________________________________________ List previous chamber repertoire_________________________________________________________ ____________________________________________________________________________________ FEES COST AMOUNT DUE $295 $50 $20 $30 $13 ________ ________ ________ ________ ________ ________ ________ ________ ADULT Tuition Steel drumming (optional) Lunch (optional -‐ $20 per week) Late registration fee (after June 5) Polo Shirt (Note Size ___________) TOTAL FEES DUE Less Deposit Amount Paid (at least $50) BALANCE DUE MUST be paid by June 5, 2015 PAYMENT METHOD ____Check enclosed ____Credit Card Information MC Visa Discover American Express Account # _______________________________________________________ Expiration Date _______ Code _______ For Office Use Only: ADDITIONAL PAYMENTS DATE AMOUNT PAYMENT METHOD NOTES ADULT VOCAL/CHORAL PACKAGE Participant Name_____________________________________________________________________ Voice: ________________________________ Do you take private lessons? (circle one) Y/N If yes, how long? _________________ Instructor’s name _____________________________________________________________________ Person providing recommendation ________________________________________________________ Have you performed in a chorus or choir before? (circle one) Y/N If so, please state where and how long ____________________________________________________ FEES COST AMOUNT DUE $150 $50 $20 $30 $13 ________ ________ ________ ________ ________ ________ ________ ________ ADULT VOCAL/CHORAL PACKAGE Tuition Steel drumming (optional) Lunch (optional -‐ $20 per week) Late registration fee (after June 5) Polo Shirt Size (Note Size________) TOTAL FEES DUE Less Deposit Amount Paid (at least $50) BALANCE DUE MUST be paid by June 5, 2015 PAYMENT METHOD ____Check enclosed ____Credit Card Information MC Visa Discover American Express Account # _______________________________________________________ Expiration Date _______ Code _______ For Office Use Only: ADDITIONAL PAYMENTS DATE AMOUNT PAYMENT METHOD NOTES YOUTH VOCAL/CHORAL PROGRAM Participant Name_____________________________________________________________________ Voice: ________________________________ Do you take private lessons? (circle one) Y/N If yes, how long? _________________ Instructor’s name _____________________________________________________________________ Person providing recommendation ________________________________________________________ Have you performed in a chorus or choir before? (circle one) Y/N If so, please state where and how long ____________________________________________________ FEES COST AMOUNT DUE $225 $45 $50 $50 $20 $30 $7 ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ YOUTH VOCAL/CHORAL PROGRAM Tuition Ukulele Instrument Purchase (Cost of instrument – you keep!) Steel drumming (optional – grade 3+) Fencing (optional – grades 7+) Lunch (optional -‐ $20 per week) Late registration fee (after June 5) T-‐shirt (Note Size ______________) TOTAL FEES DUE Less Deposit Amount Paid (at least $50) BALANCE DUE MUST be paid by June 5, 2015 PAYMENT METHOD ____Check enclosed ____Credit Card Information MC Visa Discover American Express Account # _______________________________________________________ Expiration Date _______ Code _______ For Office Use Only: ADDITIONAL PAYMENTS DATE AMOUNT PAYMENT METHOD