REGISTRATION PACKET FY Soundscapes Members are required to fill out Sections 1-9
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1 REGISTRATION PACKET FY Soundscapes Members are required to fill out Sections 1-9 SECTION 1: MUSICIAN S PERSONAL INFORMATION (please print clearly) Name: Age: Street Address: City: State: Zip Code Home Phone: Cell Phone: Where do you attend school? Do you participate in your school s band/orchestra program? [ ] YES [ ] NO What is the name of your band/orchestra teacher? SECTION 2: MUSICAL EPERIENCE What is your primary instrument? How long have you played this instrument? Is there another instrument you play? How long have you played your secondary instrument(s)? Have you played in a youth orchestra before? [ ] YES [ ] NO If so, where and for how long? SECTION 3: PRIVATE INSTRUCTION Do you currently have a private music teacher? [ ] YES [ ] NO If so, how long have you taken private lessons? If so, who is your private instructor? 1
2 SECTION 4: PARENT/GUARDIAN INFORMATION Parent/Guardian Name: Address (if different from musician): City: State: Zip Code: Home Phone Cell Phone: SECTION 5: SECOND PARENT/GUARDIAN INFORMATION, IF NEEDED Parent/Guardian Name: Address (if different from child): City: Home Phone: State: Cell Phone: SECTION 6 : EMERGENCY CONTACT INFORMATION ***REQUIRED*** Parent/Guardian Name: Address (if different from musician): City: Home Phone: State: Cell Phone: Filled out by PYO: PYO [ ] SS [ ] Orchestra [ ] Sinfonia [ ] Wind Ensemble [ ] Pro Arte [ ] 2
3 SECTION7: PYO T-SHIRT [ ] PYO T-Shirt Mandatory $10 due upon registration Size AS AM AL AL AL (Circle One) SECTION 8: PARENT/GUARDIAN VOLUNTEER OPPORTUNITY Assist the orchestra manager with tasks such as taking attendance during your child s PYO rehearsal on Monday evenings? YES NO Assist in the setup of PYO performance venues? YES NO Assist in the setup and cleanup of post-concert receptions? YES NO Provide baked goods for the concerts and/or rehearsals? YES NO Assist Orchestra Manager on concert days? Willing to chaperone? YES NO Sort and collect music? YES NO Provide a carpool for students in need of a ride to PYO rehearsals and concerts? YES NO Transport instruments to & from performance venues? YES NO Serve on a Committee? YES NO Serve on the PYO Board? YES NO Assist with fundraisers? YES NO Sell program ads? YES NO Video or record concerts? YES NO Help publicize events? YES NO Take pictures at events/rehearsals? YES NO Assist with grant writing? YES NO Write Thank you notes? YES NO 3
4 SECTION 9: PYO PHOTO RELEASE FORM Musician s Name: I grant permission to the Peninsula Youth Orchestra (PYO), its agents, or members, to use photographs taken of me during my membership in the PYO for use in PYO products, such as newsletters, display boards, websites, or other electronic forms of media, and to offer them for use or distribution in other non-pyo publications, electronic or otherwise, without notifying me. I hereby waive any right to inspect or approve the finished photographs or printed or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown. I waive any right to royalties or other compensation arising from or related to the use of the photographs. I hereby agree to release, defend, and hold harmless the Peninsula Youth Orchestra, its agents and members, including any firm publishing and/or distributing the finished product in whole or in part, whether on paper or via electronic media, from and against any claims, damages and liabilities, including but not limited to any misuse, distortion, blurring, alteration, optical illusion or use in composite form, either intentionally or otherwise, that may occur or be produced in taking, processing, reduction or production of the finished product, its publication or distribution. I am 18 years of age or older and I am competent to contract in my own name, or I am the parent/guardian of a member under age 18. I have read this release before signing below and I fully understand the contents, meanings, and impact of this release. I understand that I am free to address any specific questions regarding this release by submitting those questions in writing prior to signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release. This release will remain in effect as long as I am a member of the PYO unless I revoke it in writing. I also give permission for my contact information to be included on a roster for distribution to other PYO members. Musician s Signature Parent/Guardian Signature if under 18 years of age 4
5 SECTION 10: TERMS OF PAYMENT Musician s Name: Parent/Guardian Name: Tuition for the season is $ per musician. If you have two or more children registering, tuition is $ for the first child and $ per sibling thereafter. If you join for the Spring season ONLY, tuition is $125 per musician. You will be responsible for making all payments in full and on time. Payment is due according to the payment plan selected. All payments can be paid by attaching a check or money order payable to Peninsula Youth Orchestra. Please select your preferred tuition payment method: FULL YEAR SPRING ONLY [ ] Method 1: Payment in Full $250 due September 25, [ ] Method 2: Two Installments $125 due OCT 1, 2018 $62.50 due MAR 1, [ ] Method 3: Three Installments $85 due OCT 1, 2018 $85 due NOV 1, 2018 $85 due DEC 1, 2018 Qualified musicians will not be denied membership for financial reasons provided they make a reasonable request for tuition assistance. For information about tuition assistance contact Robin Restrepo, Orchestra Manager ASAP at info@peninsulayouthorchestra.com or call at Otherwise, tuition needs to be paid by using one of the options listed above. Thank you for your cooperation. 5
6 SECTION11: CONTRACTUAL AGREEMENT As a member of the Peninsula Youth Orchestra (PYO), I agree to abide by the policies and procedures specified in the Peninsula Youth Orchestra Handbook and pay the yearly tuition fees. This contract will remain in effect until the musician or guardian provides written notification of their resignation to PYO. Musician s Signature Parent/Guardian Signature Parent/Guardian Signature If any changes are made on this form, the musician and/or guardian must re-sign and date the contract. 6 9/9/2018
Student name: Parent/Guardian: Address/City/State/Zip:
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