Skip to main content
Skip to main content

2017 WKU Summer String Institute Registration

Registration Form

WKU Summer Strings Institute 2017

 

Please fill out all fields.  After submitting, you will receive a confirmation email.

An invoice from WKU will be mailed to the address provided below on July 1, 2017. It will have instructions on payment methods, handled through the WKU Cashier's Office. If payment is not received by July 24th, your child will not be allowed to participate.

To ensure that we have a T-shirt for your child, registration forms must be completed by July 1st.

Enter phone number: xxx-xxx-xxxx

Enter phone number: xxx-xxx-xxxx

enter "no lessons" if student has not had private lessons

Select this box to register for the SSI Violin/Viola concerto competition. Details are available here: https://www.wku.edu/strings/concerto.php

Please select only one option.

If you don't remember, type "Forgot"

Parental Consent Form

Enter phone number: xxx-xxx-xxxx

Enter phone number: xxx-xxx-xxxx

Emergency Contact

Individuals who may be contacted in the event the parent(s)/primary guardian cannot be reached.

Emergency Contact 1

Enter phone number: xxx-xxx-xxxx

Emergency Contact 2

Enter phone number: xxx-xxx-xxxx

Student Pickup Information

List of individuals, other than parents, allowed to pick your child up from the camp.  Make these individuals aware that picture ID will be required before your child will be allowed to leave with them.

Parent Consent Statement

As the parent/guardian, I certify that my child has my permission to participate in this summer music camp. I understand that he/she will be subject to the regulations of Western Kentucky University. I also agree that my child will follow the instructions of the camp personnel and will treat other campers/adults with courtesy and respect. I understand that if my child fails to do so, he/she will not be allowed to participate in the camp.

All risks associated with participating in the program, including but not limited to bodily injury, are assumed by me, as indicated by the signature below.

I understand that during music camp, participating students may be asked to complete assessment instruments that are judged appropriate. I give my permission for my child to complete these assessments and for the data to be used in research studies with the understanding that such studies will make no reference to specific students.

I understand that photographs and videos may be taken to document activities. I give my permission for photographs and/or videos to be taken of my child during the camp to be used for educational and/or promotional materials for the Department of Music and the WKU Pre-College Strings Program. 

I release and discharge Western Kentucky University, its employees, agents, and/or officers, from any and all claims, demands or damages which may arise from loss or injury of any nature as a result of any act of proven negligence on the part of the University, its employees, agents and/or officers, while my child is participating in this camp. I further agree to indemnify and hold harmless the University, its employees, agents, and/or officers from any and all loss, damage, or expense incurred.

I certify that my child’s immunizations are current and understand that I will be notified should a health emergency arise. If I cannot be reached by telephone, I authorize whatever medical treatment is deemed necessary by medical personnel.

Click here to download a PDF copy of this Consent Statement.

Type your initials to sign

NOTE: If nothing happens when clicking "Submit," please scroll to the top of this page and view the error message.

 

Twinklers Half-day                                                                    

Registration after July 1: $150

 

Young Musicians Full-day    

Registration after July 1: $200

Note: documents in Portable Document Format (PDF) require Adobe Acrobat Reader 5.0 or higher to view,
download Adobe Acrobat Reader.

Note: documents in Excel format (XLS) require Microsoft Viewer,
download excel.

Note: documents in Word format (DOC) require Microsoft Viewer,
download word.

Note: documents in Powerpoint format (PPT) require Microsoft Viewer,
download powerpoint.

Note: documents in Quicktime Movie format [MOV] require Apple Quicktime,
download quicktime.

 
 Last Modified 7/19/17