ComMUSICation - Camp & Workshop Registration

ComMUSICation Registration Form
Upcoming Camps & Workshops:

Spring Showcase with ComMUSICation's RISE and SHINE programs.
NOTE: Youth previously enrolled in Voces & Ritmo Camp do not need to fill out this form.

Date & Time: Thursday, April 24. Youth arrive at 4:30pm for the dress rehearsal (transported by guardian or by ComMUSICation - more info below).

Location: 825 Arts - 825 University Ave, St. Paul MN 55104

Showcase Ticket Information: The Showcase begins at 6pm and is free and open to the public. Please reserve your FREE ticket today. We hope to see you there!

Why do we ask for this information?
ComMUSICation participates in the Sprockets out-of-school time network, which aims to improve the quality and availability of after-school and summer programs for youth and their families in Saint Paul.

Information about your child’s participation in our programs will be used to help assess the quality and effectiveness of out of school time programs. Information about your child will be kept confidential and your child will never be identified in any evaluation or research reports. You have the right to review the Data Privacy Notice. If you do not want your child’s data to be included in evaluation or research related to Sprockets, please tell our staff and sign the non-consent form they provide. This will NOT affect your child’s participation in the program.

End of Sprockets Explainer
Full Name of Parent/Guardian*
Parent/Guardian Phone Number*
Parent/Guardian Email Address*
You may receive monthly updates, but can opt out at any time
Preferred Contact Method*
What works best for you?
Youth Participant Information
Full Name of Youth Participant*
Date of Birth*

MonthDayYear
Date
What school do you attend?*
For summer programs, enter the school you'll be enrolled in for the upcoming school year.
What grade are you in?*
For summer programs, type the grade you will be entering into for the upcoming school year.
Race/Ethnicity*

American Indian/ Alaska NativeAsianBlack/ African AmericanHispanic or LatinoNative Hawaiian or Other Pacific IslanderWhite or CaucasianMultiracialOther
Gender*

FemaleMaleTransgenderNon-binaryOther
Home Address (Street Address, City, State, and Zip Code)*
Do you qualify for free or reduced lunch?

YesNo
Are there any accommodations that would be helpful for your participation in our programs (including learning accommodations, individualized attention, technological needs, etc.)?
Emergency Contact Information: Please provide a name and phone number, as well as any other information that you think would be helpful to us in an emergency.*
Medical Conditions: Please list any medical conditions that we should be made aware of, including allergies and any specialized medications.
T Shirt Size: In many of our programs, we provide ComMUSICation t-shirts to youth participants. Please indicate your preferred t-shirt size below. "Youth" sizes are typical for elementary-aged youth.

XS YouthS YouthM YouthL YouthS AdultM AdultL AdultXL Adult2XL Adult3XL AdultOther
Transportation

In many circumstances, ComMUSICation is able to provide transportation to and from the program site. If you wish to request transportation via the ComMUSICation van, please fill out the information below, and we will communicate with our Transportation Partner to see if you can be added to the route.
I would like to request transportation to and from program (please read the options carefully)*

Yes, both waysFrom Capitol Hill to 825 Arts onlyNo, I will transport my youth both ways
Preferred PICKUP site (eg. name of school or address of home)
What time are you available for PICKUP from the site entered above? Please enter a range (eg. 2-2:50pm).
Preferred DROPOFF site (eg. name of school or address of home)
Transportation Release

ComMUSICation will be providing transportation through a contract with the nonprofit NewTrax. Newtrax is a 501(c)3 transportation nonprofit that provides transportation services for adults with disabilities, employer/corporate groups, faith communities, and health clinics. All NewTrax drivers pass a rigorous background check, receive “defensive driving” training, and are CPR certified. ComMUSICation may share family contact information with NewTrax in order to facilitate pickups/dropoffs or in case of emergency.
As a condition of transportation by ComMUSICation’s partner NewTrax, I understand and agree that: I will not hold ComMUSICation responsible for any harm or loss that may occur to my child before, during, or as a result of this transportation or release, including but not limited to, accidents, injuries, or theft; I will be responsible for, and will save ComMUSICation harmless from any claims by others for any loss, cost, or expense arising out of harm or loss that may occur to my child as a result of the transportation or release; and in an emergency, I hereby give permission to licensed medical providers selected by ComMUSICation to hospitalize, secure proper treatment, anesthesia, or surgery for my child at any expense.
Signature for Transportation Release*

Clear
Photo/Video Release

There may be times when ComMUSICation (CMC) staff, the media, or other organizations, with the approval of the Executive Director, may take photographs of students, audio/videotape students, record concerts, or interview students for CMC-related promotional or fundraising materials in a way that may individually identify a specific student (including their first name).
I grant to ComMUSICation, its staff and agents, permission to use my child’s photographs and/or videotaped images and words for the purposes mentioned above. I understand and agree that CMC may use these photos and/or videotaped images in subsequent years unless I revoke this authorization by notifying the Executive Director in writing. Furthermore, I hereby consent that such photographs, films, recordings, projects, and tapes are the property of CMC, and they shall have the right to distribute, duplicate, reproduce, and make other uses of them as they wish, free and clear of any claim whatsoever on my part. I understand that if I would like to opt out this, I must speak directly to the Music & Program Director or another Teaching Artist before the start of the activity.
Signature for Photo/Video Release*

Clear
Should be Empty:

ComMUSICation Registration Form

Upcoming Camps & Workshops:

Youth Participant Information

Transportation

Transportation Release

Photo/Video Release