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Encore Community Music Association
An Intergenerational Organization
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Academy Registration
2024-25 ENCORE ACADEMY REGISTRATION
"
*
" indicates required fields
Location
*
Carroll County - Westminster Baptist Church, 354 Crest Lane, Westminster
Howard County - Crossroads Church, 2750 Rogers Avenue, Ellicott City
Frederick County - Frederick First Church, 7899 Opossumtown Pike, Frederick
Member Name
*
First
Last
Age
*
Please enter a number from
7
to
70
.
Instrument
*
Flute
Clarinet
Bass Clarinet (3+ yrs)
Alto Saxophone
Tenor Saxophone
Trumpet
Trombone
Baritone
French Horn (3+ yrs)
Percussion
# of years of study
*
0 years - beginner
1 year
2 years
3 years
4 years
5+ years
Ensemble (Check all that apply)
*
Beginning Band
Intermediate Band
Advanced Band (Carroll only)
Jazz Band (Carroll only)
Parent Name (if different than member)
First
Last
Address
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Home Phone
*
Cell Phone
*
Email
*
Consent
*
I approve the agreement below.
I understand that by registering for this program, I irrevocably release the ECMA, Carroll County Arts Council, Carroll County Government, Westminster Baptist Church, Frederick First Church and Crossroads Church from any and all claims or liability arising from the activity, the instructor or any other person participating in the program. I also agree that photographs taken of my child or myself while participating in this activity may be used for publicity purposes. I understand it is my responsibility to provide my child with the appropriate instrument and agree to make monthly payments to the Academy by the first practice of each month. I hereby give permission for my child to participate in the Encore Academy Program.
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