Youth Registration

We will hold our youth program on Friday, June 28th from 1PM-5:30PM and Saturday, June 29th, from 9AM-5:00PM. Please pack a lunch for Saturday.

Students must have at least 2 years of playing experience and be between the ages of 11 and 18. Reading skills are not required. Sadly, we are unable to house minors and parents in the WIlliston dorms but there are nearby HOTELS you can explore if traveling from out of town. Williston is minutes away from Northampton with plenty to do for parents.

Parents will be required to provide their contact information in the registration form as well as fill out the medical form to maintain safety for your child.

Please add julielyonnmusic(at)gmail.com to your digital address-book to receive informational emails.

Register for Strings Without Boundaries 2024 Youth Program runs Friday afternoon, June 28th, and all day Saturday, June 29th. The Wednesday night concert is free and open to the community, as is the Sunday afternoon concert.

Parent's Name*
First Last
Emergency Contact Backup*
First Last
In case of an emergency, if we can’t reach you, the parent, please supply another contact name and number.
Minor's Name*
First Last
Gender
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Email*
Home Phone*
Cell Phone
Emergency Contact Backup Phone Number
Minor's Cell Phone if applicable
How did you learn about SWB? Facebook Ad? Email Newsletter? If a friend or teacher recommended our program to you, please enter his/her name here:
Number of Years Spent Playing Instrument
AGE
Instrument
- Violin/Fiddle
- Viola
- Cello
REGISTRATION CHOICES (SELECT NUMBER OF DAYS)*
Minor and parent must arrive on Friday by 1:45PM or, if only attending on Saturday, by 8:45AM. We will provide you with the address and additional information in June. Please arrive on Saturday with a packed lunch at 8:45AM, or, if you live locally, drop it off at 12:30.
Additional Comments (special needs, etc.)
CHECKOUT
*****WAIVER FORM*****REQUIRES YOUR DIGITAL SIGNATURE: All Participants*
- I have read and agree to the following terms.
In consideration of Strings Without Boundaries, New Directions Cello Festival, Williston Northampton School, and the producers of this program, I release the school, the two programs and their directors, faculty, and staff, from any and all liability to me, my parents and/or legal guardians, our personal representatives, estate, heirs, and assigns for any and all claims, demands and causes of action for any and all illness or injury to me, including death, and property damage arising out of, during or in any way connected with the program. I agree to indemnify and hold harmless, waive and covenant not to sue Strings Without Boundaries, New Directions Cello Festival, Williston Northampton School, and the producers of this program as well as faculty and staff. I release the school, the two programs and their directors, faculty, and staff, from any liability for the injury or death of any person(s) or damage to property that may result from my negligent or intentional act or omission while participating in the program. I hereby authorize the staff of this camp to act for me according to their best judgment in any emergency requiring medical attention. I authorize and give consent for 911 medics to administer general first aid for any minor injuries or illnesses experienced by me during program participation. If I need emergency medical care and staff is not able to reach my parent, family, or the emergency contact, I authorize program staff to sign all necessary papers and arrange for emergency treatment and hospital care. I understand that the program staff is not responsible for any medical expenses associated with any personal injury I may sustain and understand that I must provide my own medical insurance.
Cancellation Policies: I understand that I will forfeit a $25 processing fee if I cancel registration.*
- Check this box to indicate you’ve read and agree to these
SWB determines size of staff and all costs based on registration. If you cancel after registering, you might jeopardize the ability of the program to meet its expenses.
Please Type Your Full Name As Your Electronic Signature:*
First Last
Credit Card
Card Details
Cardholder Name
Total
$0.00
Comments
This field is for validation purposes and should be left unchanged.

MEDICAL FORM

This information is required by Williston Northampton School to ensure your child’s safety. It’s important that we create the safest environment possible for your child in case we can’t reach you. This information is confidential, and will be stored in a binder for the director of the Youth Program and the only two people to view it will be the program director for SWB (Julie Lyonn Lieberman) and the director for the Youth Program (Alissa Jackson).

Strings Without Boundaries MEDICAL FORM

Parent/Guardian's Email Address
Child's Name*
First Last
Parent's Email Address:
Birth Date for Registrant*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

This address form might confuse you because it provides a box for the address below the word “Address” but the zip code should go in the box above the phrase “zip code.” So much for automated technology… Well, at least you don’t have to fill out a form by hand!
Mother's Name*
First Last
Best phone number to call in case of emergency:
Work Phone*
Father's or Partner's Name*
First Last
Address if different from child:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Best phone number to call in case of emergency:*
Work Phone*
Name of Physician or Clinic:*
Phone
Name of Dentist:*
Phone*
Name of Insurance Company:*
Policy Number:*
Policy Holder's Name*
Group Number:
Emergency Contact (other than parents)*
First Last
Relationship:*
Emergency Contact Address:
Street Address Address Line 2 City State ZIP Code
Emergency Contact Phone*
Date of last Tetanus Shot:*
Please list special medical conditions and other medical information. Please include food allergies, medicines, insect bites/stings, asthma, diabetes, epilepsy, seizures, etc.*
Number each medical condition to create an easy-to-read list. Or type “none.”
Medications:*
Please list any medications that may need to be administered during the camp along with instructions for administration. Here is an example: 1. antibiotic (name of antibiotic): 1 pill after breakfast, 1 after dinner. 2. Asthma medication (name of medication): Only to be used when needed. Etc. OR TYPE “NONE”
Medical Treatment Consent for Minors:
Medical Treatment Consent for Minors If your child will be under age 18 while at Strings Without Boundaries on the Williston Northampton School campus. It is camp policy to secure your consent for medical treatment or medication distribution and for the use of medical devices. All medications must be in a medicine bottle and labeled with the camper’s name, doctor’s name and phone number, medication name, and dosage. Also, please complete the following for each medication: Emergency medications such as inhalers, bee sting kits, or insulin may be kept with the student. All other medications will be stored by the director of the Youth Program or, if you’re staying overnight with your child, you will keep it in the shared dorm room.
I give permission …*
- For my child to receive medical treatment in case of emergency.
Emergency Consent*
- I hereby authorize the treatment, administration of anesthesia and surgical treatment(s) for my minor child in the event of an emergency medical situation occurring during my absence or when the hospital physician(s) are unable to contact me. This authorization extends to any hospital and both physician and nursing personnel within the hospital as well as any physician where treatment is rendered in the physician’s office. I release from medical responsibility and liability, the hospital, medical authorities, and physicians for performing medical procedures acting on the authority of this medical treatment consent form that are deemed necessary for my minor child.
Minor child's name:*
Electronic Signature of Parent or Legal Guardian*
First Last

I understand that typing my name where indicated will carry the same legal weight as a signature.
Date*
MM slash DD slash YYYY

YOUTH REGISTRATION

CHECKOUT

Strings Without Boundaries MEDICAL FORM

Medical Treatment Consent for Minors: