Fall 2026 & Winter 2027 SPACE Program Registration

Parent / Guardian Contact Info
Parent/Guardian 1 - Name

First NameLast Name
Parent/Guardian 1 - Email

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

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian 2 - Name

First NameLast Name
Parent/Guardian 2 - Email

Confirmation Emailexample@example.com
Parent/Guardian 2 - Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 2 - Mailing Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Information

In an emergency, we will always contact a parent/guardian first. Please provide two additional contacts who can be reached if a parent/guardian is unavailable. Emergency contact information will only be used in the event of an emergency and will not be shared or used for other purposes.

Emergency contacts must be different from parent/guardian.
Emergency Contact 1 - Name

First NameLast Name
Emergency Contact 1 - Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact 1 - Relationship to Student
Emergency Contact 2 - Name

First NameLast Name
Emergency Contact 2 - Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact 2 - Relationship to Student

Transportation Needs
Does your student need to take the bus home in order to participate in SPACE?

Other
Scheduling Needs

Please let us know about any known scheduling considerations that may affect your student's SPACE participation, including sports, other activities, travel plans, or other commitments.

Please include any known dates, times, or regular availability that would be helpful as we plan your student's schedule.

We will do our best to work around known conflicts and accommodate makeup instruction when possible, but makeups are not guaranteed.
Scheduling needs or considerations:

Medical & Pickup Information
Medical information is used for emergencies only.
Does your student have any known allergies?
If yes, please specify:
Are your student's immunizations up to date?

Other
Date of your student's last tetanus shot:
Does your student currently take any medications that our faculty or staff should be aware of?
Please list the medication(s), dosage, and any instructions our faculty or staff should be aware of in the event 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 {pleaseChoose}. 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)
Who Can Pick Up Your Student?

Please list at least two (and up to four) additional people who are authorized to pick up your student from the SPACE Program. Anyone picking up your student who is not a parent/guardian will be asked to show a photo ID to a Caroga Arts staff member or volunteer at pickup.

Authorized Pickup contacts must be different from the parent/guardian contacts listed earlier, but they may be the same people listed as emergency contacts.
Authorized Pickup 1 - Name

First NameLast Name
Authorized Pickup 1 - Relationship to Student
Authorized Pickup 1 - Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Authorized Pickup 2 - Name

First NameLast Name
Authorized Pickup 2 - Relationship to Student
Authorized Pickup 2 - Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Authorized Pickup 3 - Name

First NameLast Name
Authorized Pickup 3 - Relationship to Student
Authorized Pickup 3 - Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Authorized Pickup 4 - Name

First NameLast Name
Authorized Pickup 4 - Relationship to Student
Authorized Pickup 4 - Phone Number
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, {parentguardian1}, give permission for {studentFirst} to be photographed and filmed.

I grant Caroga Arts Collective permission to use these photographs and videos for promotional, educational, and informational purposes, including on the Caroga Arts and SPACE websites, social media, newsletters, printed materials, and other communications or promotional materials.

I understand that these photographs and videos may be used in the future and that I will not receive compensation for their use. I release Caroga Arts Collective, its officers, board of directors, staff, trustees, and volunteers from any claims for compensation arising from the use of these photographs and videos for these purposes.
Video/Photo Release Agreement:
Signature (I am 18 years or older OR the Parent/Guardian of the participant)

Enrollment Selection
Tuition is shown with each enrollment option below. You will choose your payment method and complete payment, if applicable, on the following page.

Scholarship applicants will receive an email with their tuition amount due after their scholarship award has been determined.
Which enrollment option would you like for your student?

Registration Agreement
I, {parentguardian1}, hereby enroll {studentFirst} in the Caroga Arts Collective: String Project & Arts Collaborative Education (SPACE) Program for {whichEnrollment}.

I understand that enrollment is limited and registrations are considered in the order they are received. Caroga Arts reserves the right to decline registrations received after the registration deadline. Cancellations made at least 14 days before the program start date are eligible for a refund, minus a $50 processing fee. No refunds will be issued for cancellations made less than 14 days before the program start date.

Caroga Arts reserves the right to cancel a program registration. If a program is canceled, Caroga Arts will not be responsible for any losses incurred by registrants.
Payment Method
How would you like to pay?
for check payments:

Please mail your check to:

Caroga Arts Collective
PO Box 1048
Caroga Lake, NY 12032

Please write the student's name and "SPACE Program" in the memo.

Scholarship Application
After your scholarship application has been reviewed, you will receive an email with your scholarship award and the tuition amount due.
Has your family applied for a SPACE scholarship before?

Other
Parent/Guardian Section
Please explain your financial need.
To be completed by the parent/guardian
Please share any additional information that could help the Caroga Arts Education Committee reach a decision regarding your request for scholarship assistance.
To be completed by the parent/guardian
What is your household's approximate annual income before taxes?
To be completed by the parent/guardian
How did you hear about this program?
To be completed by the parent/guardian
Student Section
What other activities, hobbies, or interests do you have?
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 completed this application to the best of your ability and that the information provided is accurate and complete.
Student Signature
Parent/Guardian Signature
Date of Signature:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
If you have questions regarding the SPACE Program or your scholarship application, please email Stephanie Price at stephanie@carogaarts.org

Online Payment
Your enrollment selection:
{whichEnrollment}
Please complete your payment below

Select the enrollment option that matches your choice above to complete your payment:

Fall 2026: Part 1 only (6 weeks)

Part 1 (Fall) = 6 weeks, Sep 21 - Oct 30

See SPACE website for additional program information and important dates.

$100.00

Fall 2026: Part 2 only (6 weeks)

Part 2 (Fall) = 6 weeks, Nov 2 - Dec 19

See SPACE website for additional program information and important dates.

$100.00

Fall 2026: FULL SEMESTER (12 weeks)

Part 1 (Fall) = 6 weeks, Sep 21 - Oct 30

Part 2 (Fall) = 6 weeks, Nov 2 - Dec 19

See SPACE website for additional program information and important dates.

$200.00

Fall 2026 + Winter 2027 (24 weeks)

Fall 2026 = 12 weeks, Sep 21 - Dec 19

Winter 2027 = 12 weeks, Jan 25 - May 8

See SPACE website for additional program information and important dates.

$400.00

Winter 2027: Part 1 only (6 weeks)

Part 1 (Winter) = 6 weeks, Jan 25 - Mar 12

See SPACE website for additional program information and important dates.

$100.00

Winter 2027: Part 2 only (6 weeks)

Part 2 (Winter) = 6 weeks, Mar 15 - May 8

See SPACE website for additional program information and important dates.

$100.00

Winter 2027: FULL SEMESTER (12 weeks)

Part 1 (Winter) = 6 weeks, Jan 25 - Mar 12

Part 2 (Winter) = 6 weeks, Mar 15 - May 8

See SPACE website for additional program information and important dates.

$200.00

Total

Debit or Credit Card
Credit Card Number	Security Code
Expiration Month	Expiration Year

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

Questions? Please contact Stephanie at Stephanie@carogaarts.org or 614-638-9949.

Thank you!
Should be Empty:

SPACE Program Registration

Choose Your SPACE Program Location

Tell Us About Your Student

Parent / Guardian Contact Info

Medical & Pickup Information

The next set of questions are used for grant purposes only

Video/Photo Release Agreement

Enrollment Selection

Registration Agreement

Payment Method

Scholarship Application

Parent/Guardian Section

Student Section

Online Payment

Please complete your payment below

Select the enrollment option that matches your choice above to complete your payment:

Complete Your Registration

SPACE Program Registration

Choose Your SPACE Program Location

Tell Us About Your Student

Parent / Guardian Contact Info

Medical & Pickup Information

The next set of questions are used for grant purposes only

Video/Photo Release Agreement

Enrollment Selection

Registration Agreement

Payment Method

Scholarship Application

Parent/Guardian Section

Student Section

Online Payment

Please complete your payment below

Select the enrollment option that matches your choice above to complete your payment:*

Complete Your Registration

Select the enrollment option that matches your choice above to complete your payment: