Fall 2025 & Spring 2026 SPACE Program Registration

Music Experience and Goals
Level of experience on instrument*

Absolute Beginner (no prior experience)Early Beginner (basic knowledge of instrument, setup, and string names)Beginner (starting or can read basic music notes and rhythms)Intermediate (can read most sheet music, wants to develop instrument technique)Advanced (Reading scores, studying scales & arpeggios, controlling vibrato speeds, etc.)
If you have studied your STRING instrument before, how long have you be studying your instrument?
Do you have a Music Instructor(s) (i.e, Private Teachers and/or School Directors), if applicable, please list name, email, and phone number
Student Goals for Music Lessons*
Parent/Guardian's Goals for Students' Music Lessons*
Any specific areas of students focus or musical genres interests
Additional Comments or Special Requests (by students or parent/guardian)

Transportation/Scheduling Requests:
Does your child need to take the bus home to be able to participate in SPACE? Or can you coordinate pickup on your own?*

I need my child to take the bus home.I can pickup them up OR I will coordinate a pickup.My child goes to Pleasant Ave, so this question does not apply.Other
Do you participate in sports or other outside activities that would prevent you from attending the assigned SPACE day at your school? If so, please list conflicts (dates/times) so we could see how we could accommodate lessons for you.

Parent/Guardian Contact Information
Name of Parent/Guardian (1) *

First NameLast Name
Email Address of Parent/Guardian (1)*

Confirmation Emailexample@example.com
Cell Phone Number of Parent/Guardian (1) *
Please enter a valid phone number.
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Parent/Guardian (2)

First NameLast Name
Email Address of Parent/Guardian (2)*

Confirmation Emailexample@example.com
Cell Phone Number of Parent/Guardian (2)
Please enter a valid phone number.
Mailing Address (if different from Parent/Guardian (1))

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Information

We will ALWAYS contact the parent/guardians FIRST. We need at least two additional emergency contacts in addition to the parents/guardians. We will only contact them if there is an emergency. No information will be shared or used otherwise.
Emergency Contact Name (1) (must be different from parent/guardian)*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Relationship to Student*
Emergency Contact Name (2) (must be different from parent/guardian)*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Relationship to Student*
Student Medical Information

This information is used for emergencies only.
Does the student have any known allergies?*

YesNo
If yes, please specify:
Immunizations Up to Date?*

YesNoOther
Date of last Tetanus Shot:*
Currently on any Medications?

YesNo
If yes, please specify: (again this is only in case of an emergency)
To the best of my knowledge the information provided above is complete and accurate. I grant permission for my child to participate in the Caroga Arts Collective S.P.A.C.E. Program at {pleaseChoose}. I authorize the staff at the Caroga Arts Collective to carry out any first aid treatment or any treatment deemed necessary for the well-being of my child.
Signature (I am 18 years or older OR the Parent/Guardian of the participant)*
Authorized Pickup List

Please list at least 2 other authorized people who can pickup your child from the SPACE Program. You can list up to 4 authorized people. They will be required to show their ID to a CarogaArts staff/volunteer at pickup time.
Name of Authorized Pickup (1) (must be different from parent/guardian, but can be the same as the Emergency contacts)*

First NameLast Name
Relationship to Student*
Cell Phone Number of Authorized Pickup (1)*
Please enter a valid phone number.
Name of Authorized Pickup (2) (must be different from parent/guardian)*

First NameLast Name
Relationship to Student*
Cell Phone Number of Authorized Pickup (2)*
Please enter a valid phone number.
Name of Authorized Pickup (3) (must be different from parent/guardian)

First NameLast Name
Relationship to Student
Cell Phone Number of Authorized Pickup (3)
Please enter a valid phone number.
Name of Authorized Pickup (4) (must be different from parent/guardian)

First NameLast Name
Relationship to Student
Cell Phone Number of Authorized Pickup (4)
Please enter a valid phone number.
Video/Photo Release Agreement:
By participating in the Caroga Arts Collective String Project & Arts Collaborative Education (SPACE) Program, I, {nameOf}, hereby agree {studentName} to be photographed and filmed and grant the Caroga Arts Collective permission to use them for future publications in print and online for promotional purposes. I agree to release Caroga Arts Collective, its officers, board of directors, staff, trustees and volunteers from any and all claims for compensation from the videos and images used by Caroga Arts Collective.
Video/Photo Release Agreement:*

I agree (I am 18 years or older OR the Parent/Guardian of the participant)I disagree
Signature (I am 18 years or older OR the Parent/Guardian of the participant)*

Registration and Tuition Payment
I, {nameOf}, hereby enroll {studentName} in the Caroga Arts Collective: String Project & Arts Collaborative Education (SPACE) Program held at {pleaseChoose}. I understand that due to space restrictions, enrollment is limited. Students are considered in the order that completed registrations are received. CarogaArts reserves the right to refuse late registrations. A refund, minus a processing fee of $50, will be made with notice of cancellation by 14 days before the program start date. No refunds will be given for cancellations after this deadline. CarogaArts reserves the right to cancel this program registration. If the program is canceled, CarogaArts will not be responsible for any losses incurred by registrants.
Payment Agreement: *

I will apply for scholarship.I will mail a check to "Caroga Arts Collective, PO Box 1048, Caroga Lake, NY 12032" - please write in memo PARTICIPANT NAME and SPACE ProgramI will pay online now.

Scholarship Application Form
Is this your first time applying for scholarship or did you apply for scholarship in the Summer?

This is my first time applying for scholarshipI applied for scholarship assistance in the summer
This section is to be completed by the parent/guardian:
1. Please explain your financial need.*
To be completed by the parent/guardian
2. Please share any additional information that could help the Caroga Arts Education Committee reach a decision regarding your request for scholarship assistance.*
To be completed by the parent/guardian
Family Gross Annual Income:*
To be completed by the parent/guardian
How did you hear about this program?*
To be completed by the parent/guardian
These next questions are to be completed by the student
Students Other Activities/Interest:*
To be completed by the student
Who do you consider to be your musical influences?*
To be completed by the student
Why do you want to study a string instrument?
To be completed by the student
By signing below, you acknowledge that you have read and agree to the above provisions, and that you have completed application to the best of your ability.*
By signing below, you acknowledge that you have read and agree to the above provisions, and that you have completed application to the best of your ability.
Student Signature*
Parent/Guardian Signature*

Clear
Date of Signature:

MonthDayYear
Date
If you have questions regarding the SPACE Program or your scholarship application, please email Stephanie Price-Wong at stephanie@carogaarts.org

SPACE Programs Includes rental instrument, lessons/group classes, workshops, masterclasses, and final showcase concert(s). *NEW STUDENTS will start on a cardboard "build your own" violin for the first 3 lessons. On week 4, they will transfer to the real wooden instrument. **RETURNING STUDENTS will be on the real wooden instrument for the entire program.

Fall 2025: 6 weeks Part 2Weeks of Oct. 27-Dec. 8 w/showcase concerts on 11/29 & 12/12. Please refer to website for assigned school date/times.

$100.00

Winter 2026: 12 weeks ProgramWeeks of Jan. 26-April 27 w/showcase concerts on March 14 OR 15, & May 1 OR May 2. Please refer to website for assigned school date/times.

$200.00

Winter 2026: 6 weeks Part 1Weeks of Jan. 26-March 9 w/showcase concerts on March 14 OR 15. Please refer to website for assigned school date/times.

$100.00

Winter 2026: 6 weeks Part 2Weeks of March 16-April 27 w/showcase concerts on May 1 OR May 2. Please refer to website for assigned school date/times.

$100.00

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Which program are you signing up for? Note: Scholarship applicants will be invoiced after award letters have been emailed.

Fall 2025: 12 weeks Program = $200 (closed as of 9/29/25)Fall 2025: 6 weeks Part 1 = $100 (closed as of 9/29/25)Fall 2025: 6 weeks Part 2 = $100 (will close 10/13/25)Fall 2025 & Winter 2026: 24 weeks Program = $400 (closed as of 9/29/25)Winter 2026: 12 weeks Program = $200Winter 2026: 6 weeks Part 1 = $100Winter 2026: 6 weeks Part 2 = $100

Once you click submit, a confirmation will be sent to your email. Please check your spam folder if you do not see it in your inbox.

Questions? Please email Stephanie@carogaarts.org or call her cell at 614-638-9949.

Thank you!
Should be Empty:

Fall & Spring SPACE Program Registration

Student Information

Instrument: Own or Rent?

Music Experience and Goals

Transportation/Scheduling Requests:

The next set of questions are used for grant purposes only

Parent/Guardian Contact Information

Emergency Contact Information

Student Medical Information

Authorized Pickup List

Video/Photo Release Agreement:

Registration and Tuition Payment

Scholarship Application Form

This section is to be completed by the parent/guardian:

These next questions are to be completed by the student

If you have questions regarding the SPACE Program or your scholarship application, please email Stephanie Price-Wong at stephanie@carogaarts.org