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

Cumberland Youth Songwriting & Performance Camp Registration Form 2026

This day camp is held July 20-23rd at the Weird Church (United Church) Building in Cumberland, BC. We will also be using the Hidden Well Studio in Cumberland for recording. Please fill out this form and the program coordinator Tereza Tomek will contact you shortly with payment options and to confirm registration. Registration open for ages 7-18.
BURSARIES AVAILABLE- If cost is a barrier to participation please fill out the bursary request section of the application form.
Participant Name

First NameLast Name
Participant Age
Participant Birth Date

MonthDayYear
Participant Pronouns (A pronoun is a word that substitutes for a noun; in this case a word that substitutes for a participants name)

Other
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name

First NameLast Name
Home Number
Format: (000) 000-0000.
Cell Number
Format: (000) 000-0000.
E-mail
example@example.com
Emergency Information
Emergency Contact's Name 1

First NameLast Name
Relationship
Phone Number
Format: (000) 000-0000.
Alt. Phone Number
Format: (000) 000-0000.
Emergency Contact's Name 2

First NameLast Name
Relationship
Phone Number
Format: (000) 000-0000.
Alt. Phone Number
Format: (000) 000-0000.
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:
Should be Empty:

Cumberland Youth Songwriting & Performance Camp Registration Form 2026