MFC 2023 Registration Form "*" indicates required fields Choose your camp session*Please select the session for which you want to register. If you want to register for multiple sessions, you will need to re-submit the form. June Weekend June Week August Week 1 August Week 2 Type of Registration* Adult (age 18+) Unaccompanied Youth (age 12 - 17) Youth in cabin with counselor, parent on site (age 12 - 17) Youth with parent - tent or shared cabin (age 6 - 17) Child with parent - tent or shared cabin (age 3 - 5) Young child attending with parent (under 3) Contact InfoCamper Name* First Last Age*Please enter the age camper will be on the first day of camp.Date of Birth* MM slash DD slash YYYY Gender* Male Female Other Parent/Guardian Name* First Last Relationship to Camper* For youth registrations, please enter the parent's contact info.Phone*Email* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Housing selectionHousing - adult campers* Cabin Tent R.V. Music InfoPrimary instrument*Please select the instrument for which you plan to attend the most workshops. Please NOTE: some instruments are only offered during certain sessions.FiddleBanjoBassButton Accordion (June only)CelloFlute/WhistleGuitarHarmonica (August week 2 only)MandolinPianoPiano Accordion (August week 2 only)SingingUkuleleRate your level of experience* Level 1 - Early beginner (learning the basics, tuning notes) Level 2 - Advanced beginner (some experience with basic technique) Level 3 - Early intermediate (can play an easy tune slowly and steadily) Level 4 - Advanced intermediate (can play easy tunes at dance tempo) Level 5 - Advanced (can play many tunes at dance speed) Level 6 - Very advanced (ready for any challenge) Is this your first time at MFC? Yes! This is my first time at MFC! No, I've been to camp before Welcome to Maine Fiddle Camp! We're excited to meet you this summer!Welcome back to MFC! Emergency Contact infoEmergency Contact Name* First Last Emergency Contact Phone*Backup Emergency Contact Name First Last Backup Emergency Contact Phone Medical InfoPlease note: We keep this information on file to accommodate your health needs and provide emergency care. Our website is as secure as possible, but our server is not HIPAA-compliant. If you are comfortable entering your information below (at your own risk) please do so. If you would prefer to bring a paper copy of this information to camp, please download and complete the MFC health form. Thank you!Food allergiesMedical ConditionsAllergies to MedicationsPrimary Care Physician - Name and contact info Consent Parents of Unaccompanied Youth After submitting your registration, you will need to sign and submit the following forms: MFC Health Form for unaccompanied minor. MFC Emergency Medicine Permission for unaccompanied minor You can scan and email your forms to Jo-Anne Bouthot [email protected], or mail a hard copy to Jo-Anne Bouthot / Maine Fiddle Camp PO Box 55 New Portland ME 04961 Consent for Emergency Medical Treatment*Although camp-related injuries are rare, they do occur on occasion and you and/or your child may have to be taken to a medical center for treatment. By submitting this form you consent to medical treatment for you or your child in case of unexpected illness or injury, will ensure that you or your child will get prompt medical attention should we not be able to contact you personally. Also, by submitting this form, you waive any responsibility for personal injury or illness from Maine Fiddle Camp. I consent to receive emergency medical treatment for myself or my childSwim permission*Your signature below also gives permission for this child/camper to swim at places with lifeguards present. Every precaution is taken to eliminate any injury to our campers. Your signature herby waives, releases, and holds harmless from any liability for damages or claims for personal property damages which may arise in connection with riding in the camp bus or other vehicle, or swimming at Camp NEOFA, against Maine Fiddle Camp and Camp NEOFA organization and all of their officers, agents and employees. I agree to allow this child/camper to swim with lifeguards presentConsent to share contact information I agree to allow my contact information to be shared with other campers/staff.Join mailing list I would like my email added to the MFC mailing listComments or QuestionsUse this space to share anything else we should know about your registration. **Please list the names of the campers in your group, if you wish to be placed in the same cabin. PaymentPayment information: Payment deadline: May 13 for June camps, July 8th for August camps. $50 late fee applies thereafter, subject to availability. Your registration is not complete, and your spot is not secured, until we receive payment. Registration includes a $50 non-refundable registration fee, which we retain in the event you cancel your registration. Balance of fee not refundable for cancellations after May 13, 2023 for June sessions, or July 8, 2023 for August sessions. Registration includes tuition, meals, and bunk/tent site. Details forwarded after receipt of paid registration.Fee - Weekend (Adult) Price: Fee - Full Week (Adult) Price: Fee - Weekend (Unaccompanied Youth) Price: Fee - Full Week (Unaccompanied Youth) Price: Fee - Weekend (Youth/Cabin)Youth staying in cabin with counselor, parent on site. Price: Fee - Full Week (Youth/Cabin)Youth staying in cabin with counselor, parent on site. Price: Fee - Weekend (Youth/Tenting)Youth age 6-17, staying with parent in tent or shared cabin. Price: Fee - Full Week (Youth/Tenting)Youth ages 6-17, staying with parent in tent or shared cabin. Price: Fee - Weekend (Child/tenting)Child 3-5 staying with parent in tent or shared cabin. Price: Fee - Full Week (Child/tenting)Child 3-5, staying with parent in tent or shared cabin. Price: Total How would you like to pay?* Pay now by Credit Card or PayPal Mail a check Please NOTE: Your registration is not complete, and your spot is not secure until payment is received. Payment for June camps is due by May 13. Payment for August camps is due by July 8. Please note, a $50 late fee will apply to payments submitted after these dates, provided a spot is available. Please make your check payable to Maine Traditional Music Association and mail to: Jo-Anne Bouthot/ Maine Fiddle Camp PO Box 55 New Portland ME 04961 Payment MethodPayPal CheckoutCredit Card MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name CommentsThis field is for validation purposes and should be left unchanged. Δ
