CASSWA ENSEMBLE DAY

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

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 Ensemble Day

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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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In what year of playing is the participant?* This field is required.Note that Ensemble Day is targeted at players in their 2nd or 3rd year of playing.

5

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 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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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.

12

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

YESNO

13

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.

14

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

15

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

16

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

YESNO

17

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.

20

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

Date

21

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

22

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

Yes

No

23

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 Ensemble Day, CASSWA should be notified by 8.30am on the day of the event.

Refunds will only be offered under exceptional circumstances AND provided that CASSWA has been contacted before 8.30am on the day of the event.

In the event that Ensemble Day 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 upon completing the form.

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Complete Payment for CASSWA Ensemble Day* 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

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CASSWA Ensemble Day Participant PassParticipant Pass for CASSWA Ensemble Day
$10.00AUDEdit
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Quantity

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

Choose from one of the PayPal options to make your payment.