SAXOPHONE AND CLARINET ENSEMBLE DAY 27th March 2022

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Participant's Name* This field is required.'Participant' refers to the clarinet or saxophone player taking part in event

First Name

Last Name

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Participant's InstrumentIf unsure, select either option marked (Standard)

Clarinet in Bb (Standard)

Bass Clarinet

Alto Saxophone (Standard)

Tenor Saxophone

Baritone Saxophone

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Number of years participant has been playing* This field is required.

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Name of the participant's clarinet or saxophone tutor* This field is required.Ordered alphabetically by last name. If not listed click 'NOT LISTED' at the bottom.

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Please provide the name of the participant's clarinet or saxophone tutorIf unsure of first name, use 'Mr,' 'Ms,' 'Mrs' etc.

First Name

Last Name

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Participant's Date of Birth* This field is required.'Participant' refers to the clarinet or saxophone player taking part in event. Enter numbers manually.

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Participant's Mobile Contact.

Please enter a valid phone number.

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Participant's Email

example@example.com

Confirm Email

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Confirm that the participant is under 18 years of age.Contact information of a parent or guardian must therefore be submitted.

Confirm

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Guardian/Parent Name* This field is required.This is required as Emergency Contact information.

First Name

Last Name

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Guardian/Parent Mobile Contact* This field is required.This is required as Emergency Contact information.

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Guardian/Parent Email* This field is required.This is required as Emergency Contact information.

example@example.com

Confirm Email

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Guardian/Parent Address* This field is required.This is required as Emergency Contact information.

Street Address

Street Address Line 2

Suburb

State / Province

Postal / Zip Code

Country

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CASSWA requires the following questions be answered in the case of a medical emergency.

Any participants under the age of 18 that have a condition that requires treatment using any epipens, medication or other medicine should carry this treatment with them for the duration of the event.

Any participants under the age of 18 that do not self administer their epipens, medication or other medicine MUST be supervised by a parent/ guardian or appropirate caregiver for the duration of the event.

CASSWA must be informed of any changes to a participants health and/or fitness if they are under the age of 18 so that appropriate supervision can be arranged.

In the case of medical emergency, CASSWA can arrange to present the participant for medical assessment, however CASSWA is NOT liable for any costs incurred as a result of accident or illness.

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Does the participant have any allergies?CASSWA requires medical information in case of emergency and keeps all information strictly confidential.

YESNO

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Please provide details by listing the nature of the allergy and any other relevant information.CASSWA requires medical information in case of emergency and keeps all information strictly confidential.

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Is the participant subject to seizures, fainting, epilepsy, diabetes or any other condition that may affect their safety during this CASSWA event?CASSWA requires medical information in case of emergency and keeps all information strictly confidential.

YESNO

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Please provide details of the participant's conditionCASSWA requires medical information in case of emergency and keeps all information strictly confidential.

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Does the participant currently take any pills or medication?CASSWA requires medical information in case of emergency and keeps all information strictly confidential.

YESNO

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Does the participant self-administer this medication?CASSWA requires medical information in case of emergency and keeps all information strictly confidential. If a child does not self-administer their medicine, they must be supervised by a parent or guardian for the entire duration of the event.

YESNO

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Please provide details below including the name of medication, dosage & frequency of use)CASSWA requires medical information in case of emergency and keeps all information strictly confidential.

(Name of medication, dosage and frequency of use)

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CASSWA is requires participants who need epipens, medication or other forms of medicine to have them on their person at all times.CASSWA requires medical information in case of emergency and keeps all information strictly confidential.

I understand that the participant MUST have their epipens, medication or other form of medicine on them at all times for the duration of this event. If the participant does not self administer their medication I also acknowledge that a carer, parent or guardian must provide supervision to the participant throughout the event.

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What was the date of the participant's last Tetanus vaccination?* This field is required.

Date

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Do you give consent for your child to be photographed during this event and for the photos to be used by CASSWA in promotional material?* This field is required.Group photos for promotion of future events are put on CASSWAs website and facebook page.

Yes

No

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Would you like to hear about future CASSWA events via email? * This field is required.

Yes

No

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The following payment section must be submitted in order to complete registration.

Please note that CASSWA attendence is expected upon completing registration. In the case whereby a participant will be absent for ClariSax Feast, CASSWA should be notified by 8.30am on the day of the event (June 25th).

Refunds will only be offered under exceptional circumstances, provided CASSWA has been contacted before 8.30am on the day of the event (June 25th).

In the case that a participant is unwell or displaying symptoms that suggest a COVID-19 infection, we strongly encourage the participant not to attend the event and can offer a refund provided that CASSWA is contacted before 8.30am on the day of the event (June 25th).

In the event that ClariSax Feast 2023 needs to be cancelled due to circumstances outside our control, CASSWA will arrange for all payments to be refunded to the payee.

These are the terms of completing payment and will need to be acknowledged upcon completing the form.

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Complete Payment for ClariSaxFeast 2023* This field is required.Please note that payment only needs to be made for participants. No payment is required for audience members (i.e parents or family members coming along to watch)

My Bag

1

ClariSaxFeast PassPass for ClariSax Feast on 25th June 2023 at UWA Conservatorium of Music
$30.00AUD+Edit
Back

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I warrant that the information provided in this form is current and correct and acknowledge the terms and conditions regarding payment* This field is required.

I warrant that the information provided in this form is current and correct

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Signature* This field is required.Click and drag your mouse cursor to sign

Clear

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Payment Methods

Debit Or Credit Card

First Name

Last Name

Credit Card Number

Security Code

Card Expiration

Please click one of the PayPal options to complete payment and submit the form.

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