Participant(s) Name:___________________________________ Age:___________________

Parent(s) Name:_____________________________________________________________

Address:__________________________________________________________________

Phone:__________________________________  E-mail:____________________________

Instruments you would like to have lessons on (check all that apply):

_____Beginning fiddle_____Beginning piano

_____Intermediate fiddle_____Intermediate piano

_____Beginning guitar_____Other Interest

If you are unsure about the level to mark for your instrument, please state your instrument name and the hardest two tunes you can play on the instrument:

________________________________________________________________________

________________________________________________________________________

Volunteers:  If you would be willing to help with cooking and kitchen duty or running an activity (games, arts and crafts, talent show, evening activities, chaperoning, registration) let us know what you would like to do: ________________________________________________________________________

________________________________________________________________________

Note:  If child is under 10 years of age or in need of special supervision, we ask that a parent accompany the child for the weekend.  If parent will be eating all meals with us, Please include a $20.00 fee for the parent.

Kamp Fee:  $20 fee for each child attending; Family maximum $50.00

Please send an application for each participant and the appropriate fee to:

Kids Kamp NYSOTFA, PO Box 24, Redfield, NY 13437

Checks should be made payable to:  New York State Old Tyme Fiddler's Association

PHOTO AND MEDIA RELEASE FOR MINORS

NAME OF PARTICIPANT: ____________________________________________________________________

(Last)(First)(Middle)

Name of Parent/Guardian: ____________________________________________________________________

Address:__________________________________________________________________________________

City: ___________________________________  State: ___________   Zip Code: _______________________

Phone:__________________________________  Email:____________________________________________

I, Parent/Guardian of ____________________________, do hereby consent to the use of photograph(s) of the above-named participant(s), taken at the Annual Kids Kamp, held at 1121 Comins Road, Osceola, by the New York State Old Tyme Fiddlers’ Association (NYSOTFA), its assignees or successors, on its association web site and for promotion of the Kids Kamp through similar media.

Furthermore, I hereby consent that such photographs are the property of the NYSOTFA.

Permission is granted until such time as I have provided written notice to the Board of Directors of the New York

State Old Tyme Fiddlers’ Association, PO Box 24, Redfield, NY 13437, requesting that said photograph(s) be removed from  publication.

SIGNATURE:______________________________________DATE: _______________________________

(Parent or Guardian)

Kids Kamp Registration Form

Saturday August 11th and Sunday August 12th, 2012

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