Registration Form 1 2 3 4 Camper informationsYour name* First name Last name Email* Phone 1*Phone 2Mailing address* Address City State / Province ZIP / Postal code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Your age*This information will remain private!Please enter a value less than or equal to 200.Gender*MaleFemaleAre you vegetarian*YesNoInstrument*Select your primary instrument or tell us if you are accompanying somebody. NOTE: An accompanying person may not participate in music classes.FiddleGuitarPianoAccompanyingLevel*Consult the classes descriptions if you're not sure about your level.SelectBeginnerIntermediateAdvancedExpert Parent informationsName of accompanying adult*Name of one parent*Parental commentsPlease note that campers under 16 years old MUST be accompanied by an adult. For parents who will not be present, do you have any comments or observations to share regarding your child? Health cardHealth insurance numberFor Canadians.Emergency contact* Relationship*Phone 1*Phone 2Emergency contact 2*In case of non-response of the first contactRelationship*Phone 1*Phone 2Do you have allergies or important dietary restrictions?*YesNoPlease specify allergies and if these are vital.Do you suffer from other allergies?*If yes, please explain below (types of medication, bee stings, etc.). Please let us know if you carry an EpiPen at all times.YesNoAllergy detailsDo you carry an EpiPen?*YesNoIf so, do you have it at all times?YesNoHave you had an operation or been hospitalized recently?*If yes, please explain below.YesNoHospitalization detailsAre you taking any medication?*If yes, please explain below.YesNoMedication details Special requestsYour notes...Violon trad Québec will allocate the rooms taking into account the family link, the sex and the age of the participants. He will do his best to accommodate your requests however he can not commit himself to answer them.Payment method*Please tell us how you will pay.OnlineBy chequeMusician inscription Price: $ 810.00 CAD Accompanying inscription Price: $ 560.00 CAD Inscription Espace-temps cottage reservation Donation0 $15 $25 $50 $100 $Total $ 0.00 CAD Mailing list I authorize Violon Trad Québec to add my email to the camp mailing list in order to better communicate with me. I understand that I can manage my subscription at all times. Terms and conditionsI authorize Violon Trad Québec to use my images and recordings exclusively for promotional or research purposes.Agreement* I have read and accept the terms and conditions for my participation at Camp Violon Trad Québec. I understand that all information I have provided will be treated as confidential by the camp. Anti-spamPlease prove that you're human!