Congratulations!

We look forward to welcoming you to the HIMA USA

Junior String Workshop

August 13 -18, 2023

Registration

Confirm your participation in the HIMA USA 2023 Junior String Workshop by filling out the below form and paying your deposit of 50% of the tuition (you may also choose to pay the tuition in full). If you are registering more than one child, please complete a separate registration form for each child. The Junior String Workshop dates are August 13 - 18, 2023. The program begins on August 13 at 8:30 am. If you are traveling from out of town, it is recommended that you arrive in the Lakeside area on August 12 in order for your child to be ready to start the workshop on the morning of August 13. Final festival activities (final concerts) will take place in the afternoon and evening of Friday, August 18.

Workshop hours will be 8:30 a.m. to 3 p.m. On Friday, August 18, final concert activities will take place through the evening. HIMA USA will not provide supervision of children outside of the workshop hours. All workshop instructional activities (lessons, coachings, master classes) will take place at the Danbury School located adjacent to the Lakeside Chautauqua main gates. Concerts will take place within the Lakeside Chautauqua campus. Artist-faculty concerts and advanced string quartet concerts will take place on some evenings during the festival and junior string workshop participants are encouraged (but not required) to attend these concerts with their adult guardians.

Tuition: $800, includes daily lunch provided on site and an admissions pass to Lakeside Chautauqua for one child.

Housing is not included in the tuition fee and must be secured independently. We encourage you to secure your lodging as soon as possible as demand for vacation housing is high in this area. Lakeside Chautauqua is offering a special hotel rate of $115/night per room for stays at the Fountain Inn for HIMA USA participants! Call the hotel at 419-798-4461, ext. 230 to make your reservation or learn more. Participants and their adult guardians are encouraged to consider making a family trip out of this week and secure housing within this private, lakefront community of Lakeside Chautauqua and take advantage of the many additional recreational and cultural activities offered. Learn more about the variety of housing options including cottage rentals, hotels, etc.

Lakeside Passes: Purchase your additional Lakeside Chautauqua passes for parents, guardians and other family members here. Your HIMA USA student will receive a Lakeside pass as part of their camp registration. Please note that a Lakeside Chautauqua pass is not needed to enter the Danbury School where the daily instructional activities will take place. Passes are only needed to attend the HIMA USA concerts at Lakeside Chautauqua. However, if you have secured housing within the Lakeside Chautauqua gated community, you will need passes in order to enter the gates.

For additional questions, please contact HIMA USA at info@himafestivalusa.org or 440-707-6611.

Registration Form

Student Name

First Name

Last Name

Instrument

Violin

Viola

Cello

Student Date of Birth

YYYY

Adult Guardian #1 Name

First Name

Last Name

Adult Guardian #1 Phone

(###)

###

####

Adult Guardian #2 Name

(Optional)

First Name

Last Name

Adult Guardian #2 Phone

(Optional)

(###)

###

####

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

List any of your student's allergies here

List any dietary restrictions here

Is there anything else you wish for us to know? If so, use this space to share this information.

Emergency Contact Name #1

First Name

Last Name

Emergency Contact #1 Phone

(###)

###

####

Emergency Contact #2 Name (optional)

First Name

Last Name

Emergency Contact #2 Phone (optional)

(###)

###

####

Primary Care Physician

Please list: 1) Name 2) Phone number 3) Address

Medical Insurance

Please list 1) Insurance Carrier/Plan Name 2) Policy Number 3) Subscriber Name 4) Subscriber's Relationship to Child

Pick Up Authorization

Please list the first and last names of all people authorized to pick up your child after HIMA USA camp each day.

RELEASE: By writing my name in full below, I understand and authorize the statement below.

In case of emergency, accident, or serious illness to the student named on this form in which medical treatment is required, I (parent/guardian) request HIMA USA to contact me. If the school is unable to reach me, my name below authorizes HIMA USA to exercise their own judgment in contacting the physician indicated on this form and to follow his/her instructions. If this physician is unavailable, the school may make whatever arrangements are necessary to transport the student to a hospital emergency room.

Waivers and Informed Consent: By writing my name in full below, I understand and authorize the statement below.

I as parent/guardian of my enrolled child, hereby assume all risks and hazards incidental to the conduct of the activities at Harpa International Music Academy USA (hereafter referred to as HIMA USA). My child is fit for the program(s) in which I have enrolled him/her. I hereby release and shall defend, indemnify and hold harmless HIMA USA, their board of directors, representatives, agents, employees, volunteers, members, sponsors, promoters, and affiliates (collectively “releasees”) from every claim and any liability that I or my child may allege against releasees (including reasonable legal fees and costs) as a direct or indirect result of harm to me or my child because of my child’s participation in any HIMA USA programs, whether caused by the negligence of releasees or others to the maximum extent permitted by law. I promise not to sue releasees on my behalf or on behalf of my child regarding any claim arising from or related to my child’s participation in any HIMA USA program(s). I acknowledge that, by agreeing to this document, I am releasing releasees from liability. This sign up and release form are a contract with legal and binding consequences and it applies to all activities in which my child engages during the summer camp at HIMA USA, regardless of whether such activity is a part of a formal program. I have read this release carefully before agreeing. I understand what this release means and what I am agreeing to by accepting. I understand that no insurance coverage for participants in these activities is provided by HIMA USA. By registering for this program, I understand and agree that if a portion of the program is unable to be completed due to unforeseen circumstances under responsibility of HIMA USA, I will receive a prorated refund for the uncompleted portion of the program. I also understand that no refunds or proration will be given for any other reason.

Media Permission: By writing my name in full below, I understand and authorize the statement below.

I consent to the use by HIMA USA, without further consideration, of photographs, videos, audio recordings and other media representing of the student, for advertising or other purposes.