| First Name of Participant: | *
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| Last Name of Participant: | *
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| First Name of Parent or Guardian: |
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| Last Name of Parent or Guardian: |
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| Address of Participant: | *
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| Apt. |
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| City: | *
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| Province:. | *
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| Postal/ Zip Code: | *
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| Country: | *
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| Daytime Telephone (ext.): |
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| Evening Telephone: |
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| Cell Phone: |
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| Contact Email: | *
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Please note that a valid Email must accompany this registration.
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MEDICAL INFORMATION
Please provide a contact person in case of emergency: |
| First Name: | *
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| Last Name: | *
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| Telephone Number: | *
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| Cell Phone: |
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| Email: | *
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| Has the participant ever suffered from asthma, heart problems, breathing problems or any other medical issue that may affect his/her ability to participate in this program? |
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| Is the participant on any medication? |
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| Does the participant have any allergies? |
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| Please specify: |
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DATES & ENRY DEADLINES
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| Please indicate the session which you are interested in having your child participate in by checking the boxes below: | Session I: August 4th, 2009 to August 7th, 2009
Session II: August 10th, 2009 to August 14th, 2009
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| Date of Birth (dd/mm/yy): | *
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Participants must be between 7 and 16 years of age. Age limits will be strictly adhered to, and the exact date and year of birth must be entered on the entry form. Exceptions may be made at the discretion of the Executive Director. Arts Integra reserves the right to request supporting documentation for proof of age at any time. Any misrepresentation may result in disqualification from the programs with no refund given. |
| Age as of January 1st: | *
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| Please list the name of the School, which you currently attend: |
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| Please list the name of the Studio, which you currently attend (if applicable): | *
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| Please indicate the School Grade which applies to you: | *
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LEVEL OF STUDY
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| Please indicate which best applies: | Private Lessons
School Lessons
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TEACHER INFORMATION
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| First Name of Teacher: | *
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| Teacher Last Name: | *
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| Teacher or School Address: | *
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| Apt. |
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| City: | *
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| Country: | *
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| Postal Code: | *
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| Daytime Telephone: | *
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| Evening Telephone: |
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| Cell Phone: |
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| Email: | *
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BIOGRAPHY
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| Participants are asked to include a brief biography of no more than two hundred and fifty (250) words, outlining their previous training, artistic and educational experiences and accomplishments to date. If the applicant has no previous experience, please give a short summary of why they wish to participate in this Summer Camp. Point form is acceptable. |
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CONTACT ADDRESS:
Upon full and accurate completion of registration, all entry submission materials must reach the International Summer Program office no later than the Entry Deadline Closing date addressed to:
ARTS INTEGRA
INTERNATIONAL SUMMER PROGRAMS
Arts Integra Centre for Music and the Arts
132 Main Street
Unionville, Ontario
L3R 2G4
CANADA
For inquiries or further information, please contact the Summer Program Office at info@artsintegra.com or call (905) 471-3001.
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| SUGGESTIONS |
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| We welcome your contribution of ideas and suggestions for how we can improve our Summer Programs. Please feel free to give any recommendations that you may have. |
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