2023: Fiddle & Jam Event/Anti-Contest Registration
This form is to register for events included in Fiddle & Jam weekend, June 3-4, 2023.

There are also many free community jams, concerts, and dances that do not require registration! 

You may enroll for multiple activities on one form.  Additional people need a separate form.

Events on this form include: 
  • Fiddle Orchestra for kids
  • Workshops for ages 5th grade to adult
  • Fiddle "Anti-Contest" for all ages 
To learn more about these events visit our website  or see the Facebook event page for Fiddle & Jam Weekend. 

For questions send an email to info@c-4a.org or call 217-384-5150 and leave a phone message (no text)

This form must be electronically signed by a legal adult or parent/legal guardian of underaged student.

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Email *
Student Information
Student First Name *
Student Last Name *
Student Is *
Birth Date
Required if Student is under 18
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Youth Fiddle Orchestra: for grade school through high school age students
Fiddle Orchestra will meet Saturday morning; participants will have an opportunity to sit in with the dance band on Sunday. Please see our website for details.  Fiddle orchestra details 
$5 registration fee covers Saturday lunch, sheet music, and student workshops. Please see below for discussion about available scholarships and payment options.
Please check all that apply to you.
What instrument do you play?
Name a piece you can play well.  If you know one from Suzuki or Essential Elements books please tell us that one.  Or tell us how long you have been playing.
Workshops for adults and older kids (5th grade and older)
Choose from these workshops!  Workshop details  Workshops are $5 for one, $10 for two, $15 for three, or $15 for 4 (4 for the price of 3!) Please see below for discussion about available scholarships and payment options.
Session #1: Saturday at 12:45 pm.   
These workshops are all for people with at least some skill on their instrument. Details
Clear selection
Session # 2: Saturday at 2:00 pm. 
These workshops are all for people with at least some skill on their instrument. Details
Clear selection
Session # 3: Saturday at 3:15 pm. 
There is one workshop for beginners in this session; others are for people with some skill on their instrument. Details
Clear selection
Session # 4:  Saturday at 4:30 pm. 
This session includes a dance workshop with no skill requirement!  Details
Clear selection
Fiddle Anti-Contest!
For anyone who wants to play a dance piece and receive comments from our judges!  Recommended styles include hoedown, breakdown, waltz, fiddle rag, Irish jig or reel, or other traditional dance pieces.  Baroque period pieces that are obviously for dancing are OK, but this event is not suitable for longer classical forms like rondos, sonatas, etc.  Fiddle Anti-Contest details

There is a $5 registration fee to perform in the anti-contest. Please see below for discussion about available scholarships and payment options.
Sign up for the Anti-Contest! (check all that apply)
Adult Participant or Parent/Guardian of Youth Participant
First Name *
Last Name *
Email *
Phone *
Why do we want to know where you live?
We don't need your mailing address, just city, state and zip code. It helps us know who we are serving for granting purposes.  Thanks for telling us! 
City *
State *
Zip *
Optional: Additional parent or guardian
First Name
Last Name
Email
Phone Number
Emergency Contact Information
Who should we call in the event of a medical emergency?
First Name *
Last Name *
Relationship *
Phone Number *
Alternate Phone Number
Does the participant have any medical conditions, concerns, or modifications we should be aware of?
  This information will be shared only with relevant C4A staff.


Medical Concerns? *
Medical details
Payment Options
The fee for Fiddle Orchestra is $5, and includes Saturday morning instruction, Saturday lunch, Sunday warmup, and dance. 

We are asking $5 for each workshop, or $15 for all 4 sessions.  

There is a $5 registration fee to perform in the Fiddle Anti-Contest.

Thanks to funding from an Urbana Arts & Culture grant, we are able to offer scholarships to all of these activities in the case of financial need.

Please select your payment option below. Use this link to make your payment online via credit or debit card.  

Payment may be made by check mailed to C4A at 103 N Race St, Urbana IL 61801.

We can also accept cash payment; please email or call us to make an appointment to drop it off.  
mailto:info@c-4a.org  217-384-5150

Please indicate your payment method and amount: *
Required
Finalizing Your Registration
Please read and understand the Consent and Acknowledgement and Medical Release and Authorization below and then sign in the Confirmation Area below before submitting this form.
Would you like to receive C4A newsletters? Please check all that apply.
How did you hear about this program?
Questions? Comments? Suggestions?
Informed Consent and Acknowledgement
I hereby give my approval for my child’s (or my) participation in any and all activities prepared by the Community Center for the Arts during the selected activities(s). I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless the Community Center for the Arts, and all its respective officers, agents, and representatives from any and all liability for injuries to said student arising out of traveling to, participating in, or returning from selected sessions.

In case of injury to said participant, I hereby waive all claims against the Community Center for the Arts including all instructors, staff, and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.

Photographs and videos taken during our activities may be used for our promotional purposes without your further consent.  We will not publish or release images that are inappropriate or identify students by name or otherwise reveal their identities.  

Participants' names may be listed in programs, on CDs or DVDs, or other media.  They will not be listed in a way that identifies individuals.  Said media will be available to the participant and their family.

I agree to follow safety protocols,  as listed on the C4A website and in-house signage,  in response to COVID-19 or other health concern.

Participants, their families, and their guests are all responsible for their own safety during participation in our events, whether on or off our premises.  

Participants, their families, and their guests are all responsible for their own belongings and equipment during participation in our events, whether on or off our premises.
Medical Release and Authorization
As Parent and/or Guardian of the named participant, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed. If the participant is an adult, the same release and authorizations apply, with contact attempt being made with designee listed under emergency contacts.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named student. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to the Community Center for the Arts and its affiliates including Directors, teachers, staff, and volunteers to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Confirmation
BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Adult participant or Parent/guardian of minor may sign by typing name here: *
A copy of your responses will be emailed to the address you provided.
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