Clone of 2025 SPACE Summer Programs

Student Contact Information
Email

Confirmation Email
Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Contact Information
Student Email (if applicable)
example@example.com PLEASE DO NOT INCLUDE SCHOOL EMAILS - ONLY INCLUDE IF A STUDENT HAS A NON-SCHOOL EMAIL ADDRESS
Student Cell Phone Number (if applicable)
Please enter a valid phone number.Format: (000) 000-0000.
Name of Parent/Guardian (1)

First NameLast Name
Email Address of Parent/Guardian (1)

Confirmation Emailexample@example.com
Cell Phone Number of Parent/Guardian (1)
Please enter a valid phone number.Format: (000) 000-0000.
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Parent/Guardian (2)

First NameLast Name
Cell Phone Number of Parent/Guardian (2)
Please enter a valid phone number.Format: (000) 000-0000.
Mailing Address (if different from Parent/Guardian (1))

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Music Experience and Goals
Level of experience on instrument
If you have studied your instrument before, how long have you be studying your instrument?
Do you have a Music Instructor(s) (i.e, Private Teachers and/or School Directors), if applicable, please list name, email, and phone number
Student Goals for Music Lessons
Parent/Guardian's Goals for Students' Music Lessons
Any specific areas of students focus or musical genres interests
Additional Comments or Special Requests (by students or parent/guardian)

Transportation/Scheduling Requests:
For Johnstown & Gloversville Students Only: Does your child need transportation to Sherman's Park to be able to participate in one or both of the SPACE Summer Programs?

Other

Were you in the Fall 2025 or Winter 2026 SPACE In-school Program?
Has any of your emergency, medical information or approved pickup list changed since you last registered?

Emergency Contact Information

We will ALWAYS contact the parent/guardians FIRST. We need at least two additional emergency contacts in addition to the parents/guardians. We will only contact them if there is an emergency. No information will be shared or used otherwise.
Emergency Contact Name (1) (if student is under the age of 18, contact must be different from parent/guardian)

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Student
Emergency Contact Name (2) (if student is under the age of 18, contact must be different from parent/guardian)

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Student

Student Medical Information

This information is used for emergencies only.
Does the student have any known allergies?
If yes, please specify:
Immunizations Up to Date?

Other
Date of last Tetanus Shot:
Currently on any Medications?
If yes, please specify: (again this is only in case of an emergency)
To the best of my knowledge the information provided above is complete and accurate. I grant permission for my child to participate in the Caroga Arts Collective S.P.A.C.E. Program at Sherman's Park. I authorize the staff at the Caroga Arts Collective to carry out any first aid treatment or any treatment deemed necessary for the well-being of my child.
Signature (I am 18 years or older OR the Parent/Guardian of the participant)

Authorized Pickup List

Please list at least 2 other authorized people who can pickup your child from the SPACE Program. You can list up to 4 authorized people. They will be required to show their ID to a CarogaArts staff/volunteer at pickup time.
Name of Authorized Pickup (1) (must be different from parent/guardian, but can be the same as the Emergency contacts)

First NameLast Name
Relationship to Student
Cell Phone Number of Authorized Pickup (1)
Please enter a valid phone number.Format: (000) 000-0000.
Name of Authorized Pickup (2) (must be different from parent/guardian)

First NameLast Name
Relationship to Student
Cell Phone Number of Authorized Pickup (2)
Please enter a valid phone number.Format: (000) 000-0000.
Name of Authorized Pickup (3) (must be different from parent/guardian)

First NameLast Name
Relationship to Student
Cell Phone Number of Authorized Pickup (3)
Please enter a valid phone number.Format: (000) 000-0000.
Name of Authorized Pickup (4) (must be different from parent/guardian)

First NameLast Name
Relationship to Student
Cell Phone Number of Authorized Pickup (4)
Please enter a valid phone number.Format: (000) 000-0000.

Video/Photo Release Agreement:
By participating in the Caroga Arts Collective String Project & Arts Collaborative Education (SPACE) Program, I, {nameOf}, hereby agree {studentName} to be photographed and filmed and grant the Caroga Arts Collective permission to use them for future publications in print and online for promotional purposes. I agree to release Caroga Arts Collective, its officers, board of directors, staff, trustees and volunteers from any and all claims for compensation from the videos and images used by Caroga Arts Collective.
Video/Photo Release Agreement:
Signature (I am 18 years or older OR the Parent/Guardian of the participant)

Registration and Tuition Payment
I, {nameOf}, hereby enroll {studentName} in the Caroga Arts Collective: String Project & Arts Collaborative Education (SPACE) Program held at Sherman's Park. I understand that due to space restrictions, enrollment is limited. Students are considered in the order that completed registrations are received. CarogaArts reserves the right to refuse late registrations. A refund, minus a processing fee of $50, will be made with notice of cancellation by 14 days before the program start date. No refunds will be given for cancellations after this deadline. CarogaArts reserves the right to cancel this program registration. If the program is canceled, CarogaArts will not be responsible for any losses incurred by registrants.
Payment Agreement:

Scholarship Application Form
Is this your first time applying for scholarship or did you apply for scholarship in the Fall/Winter SPACE Program?
If you are re-applying. Did your financial need or Family Gross Income change since you last applied in Fall 2025 or Winter 2026? If yes, you will be asked to update your form. If no, we will reference your most recent application from either Fall 2025 or Winter 2026.

This section is to be completed by the parent/guardian:
1. Please explain your financial need.
To be completed by the parent/guardian
2. Please share any additional information that could help the Caroga Arts Education Scholarship Committee reach a decision regarding your request for scholarship assistance.
To be completed by the parent/guardian
Family Gross Annual Income:
To be completed by the parent/guardian
How did you hear about this program?
To be completed by the parent/guardian
These next questions are to be completed by the student
Students Other Activities/Interest:
To be completed by the student
Who do you consider to be your musical influences?
To be completed by the student
Why do you want to study a string instrument?
To be completed by the student
By signing below, you acknowledge that you have read and agree to the above provisions, and that you have completed application to the best of your ability.
By signing below, you acknowledge that you have read and agree to the above provisions, and that you have completed application to the best of your ability.
Student Signature
Parent/Guardian Signature
Date of Signature:

MonthDayYear
Date
If you have questions regarding the SPACE Program or your scholarship application, please email Stephanie Price at stephanie@carogaarts.org

2026 SPACE Summer Camp

SPACE Summer Camp (Early Bird Discount by July 1)

August 10-15 9:30am-12pm

$175.00

SPACE Summer Camp (Registration Closes July 24)

August 10-15

9:30AM-12PM

$185.00

Total

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Which program are you signing up for? (If you applied for scholarship, you will be invoiced after your scholarship award has been applied)

Once you click submit, a confirmation will be sent to your email. Please check your spam folder if you do not see it in your inbox.

Questions? Please email Stephanie@carogaarts.org or text/call her cell at 614-638-9949.

Thank you!
Should be Empty:

2026 SPACE Summer Registration Form

Student Information

Instrument: Own or Rent?

Student Contact Information

Contact Information

Music Experience and Goals

Transportation/Scheduling Requests:

The next set of questions are used for grant purposes only

Emergency Contact Information

Student Medical Information

Authorized Pickup List

Video/Photo Release Agreement:

Registration and Tuition Payment

Scholarship Application Form

This section is to be completed by the parent/guardian:

These next questions are to be completed by the student

If you have questions regarding the SPACE Program or your scholarship application, please email Stephanie Price at stephanie@carogaarts.org

2026 SPACE Summer Camp