Cumberland Youth Songwriting & Performance Camp Registration (Aug. 18-21st, 2025))

Cumberland Youth Songwriting & Performance Camp Registration Form 2025

Aug. 18-21st 2025 based at Weird Church (United Church) Building in Cumberland, BC. We will also be using the Cumberland Museum and Hidden Well Studio for some programming. Please fill out this form and the program coordinator Tereza Tomek will contact you shortly with payment options and to confirm registration. If you are wishing to request a bursary towards registration please email woodstovefestival@gmail.com.
Participant Name

First NameLast Name
Participant Age
Participant Birth Date

MonthDayYear
She/HerHe/HimThey/ThemOther
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name

First NameLast Name
Home Number
Cell Number
E-mail
example@example.com
Emergency Information
Emergency Contact's Name 1

First NameLast Name
Relationship
Phone Number
Alt. Phone Number
Emergency Contact's Name 2

First NameLast Name
Relationship
Phone Number
Alt. Phone Number
Does the participant have any allergies or medical conditions the camp staff should know about? If yes, please describe.
Does the participant have any special needs or require extra support from camp instructors? Please let us know anything that would be helpful to make sure your youth has a safe and positive experience!
Does the participant have any experience in the performing arts (writing songs, performing, playing an instrument etc.) **Experience is NOT required to register! We are here to try new things together**
Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Please check all that apply:

I consent to camp instructors calling a medical practitioner or ambulance in the case of accident or illness if I cannot be immediately reached.I consent to photos of my dependant being taken during the program or at the performancesI consent to photos of my dependant being used in promo for future songwriting and performance camps.
Should be Empty:

Cumberland Youth Songwriting & Performance Camp Registration Form 2025