Fiddle Orchestra, Workshops, & Anti-Contest, June 11-12, 2022
This form is for students aged 17 and under to register for events included in Fiddle & Jam weekend.  18 year old high school students may also use this form.

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

Adults should use this form:
https://forms.gle/CGB8U18Bo7gYu7gX7
Youth age 17 and below should use this form (parent/guardian signature required)
https://forms.gle/sAEPNGFmG1GNMU687

To learn more about these events visit c-4a.org or see the Facebook event page for Fiddle & Jam Weekend  @C4ArtsUrbana

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 parent or legal guardian.

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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 Participants
Fiddle Orchestra will have Saturday and Sunday sessions, plus a performance at Sunday showcase. Please see our website for details.  c-4a.org 
$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. *
Required
Workshops
In addition to the big fiddle orchestra, you may choose from these breakout sessions.  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.  "Trick & Fancy Fiddling" with Charlie Walden, Jessie Stark, & friends! You can try any of the items listed below, but it will help us plan if you say which you are interested in. (Check all that apply)
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Session # 2: Saturday at 2:00 pm. (Choose one.)  Please see website for descriptions https://c-4a.org/happenings/48-hour-old-time-jam/
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Session # 3: Saturday at 3:15 pm. "Cross-Tuned Fiddle" with Kathleen Everingham; for fiddlers with at least a couple of years experience
Clear selection
Session # 4:  Saturday at 4:30 pm. "Dressing Up a Tune" with Charlie Walden; for players with at least a couple of years experience
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.  Please see our website for more details.  https://c-4a.org/happenings/48-hour-old-time-jam/ 

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)
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.
Parent/Guardian Information
If you are a legal adult you may either put your own information here, or use your parent's information.
First Name *
Last Name *
Email *
Phone *
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 student 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 afternoon instruction, and Sunday afternoon concert.

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 card.  
https://omella.com/0rp1m 

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.
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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 student, 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.  

Students' 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 student and his/her 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.

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

Students, 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 student, 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.

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.

*If an adult student, the same release and authorizations apply, with contact attempt being made with designee listed under emergency contacts.
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 student 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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