REGISTRATION FORM

Please select one of the following: *

I am registering myself

I am registering on behalf of the participant

Name of Participant *

First Name

Last Name

Gender of participant *

Please select one

Male

Female

Other

I prefer not to say

Phone number of participant (if applicable)

Best number to contact you directly.

Country

(###)

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Date of birth *

MM

DD

YYYY

Phone Number of Parent/Guardian *

Best number to contact you directly

Country

(###)

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Name of Instructor *

First Name

Last Name

Phone *

(###)

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If my programme is at the maximum time limit of my category, I understand that my performance may be cut short if I exceed the time limit. *

I understand and accept

Will you have an accompanist/collaborative artist? *

Please select one

Yes

No

Name of accompanist/collaborative artist (if applicable)

First Name

Last Name

Phone

Contact of accompanist/collaborative artist (if applicable)

(###)

###

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Accompanist/Collaborative artist set up *

Please select one:

Full stick

Half stick

Closed

Not Applicable

By selecting YES, I confirm I have read and will adhere to the Pathway Programs' rules and regulations. *

Link to Rules & Regulations: https://www.pathwaysprogram.ca/rules-and-regulations

Yes

By selecting YES, I hereby certify that I have read the Media Consent and Release Liability statement and fully understand its terms and conditions. *

Link to Media Consent: https://www.pathwaysprogram.ca/media-consent-and-release-liability-statement

Yes

Would you like to help volunteer? *

If you volunteer - you're eligible to receive a 50% rebate of your registration at the end of the program! [First 25 applicants only]

Yes - I would love to help!

No - I am unavailable.

Name of Volunteer

First Name

Last Name

Phone number of volunteer

(###)

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