Ensemble 1 BRAVURACONCERTJAZZ1JAZZ2PERCUSSIONPRINCIPALSTRINGSYMPHONYWIND

Ensemble 2 BRAVURACONCERTJAZZ1JAZZ2PERCUSSIONPRINCIPALSTRINGSYMPHONYWIND

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Status Audition ConfirmedAudition SentDoneExtended PaymentsFinancial AidKUBTECNot JoinPezzella ScholarshipPlacement ConfirmedPlacement SentReceived FirstReceived SecondSecond Pmt SentThird Pmt Sentwithdrew

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Update record for ,. RegisterId:

Student Last Name*

Student First Name*

Instrument* Baritone Bass Bassoon Cello Clarinet Flute French horn Harp Oboe Percussion Saxophone-Alto Saxophone-Baritone Saxophone-Tenor Trombone Trumpet Tuba Violin Viola

Grade (2019-2020)* 4 5 6 7 8 9 10 11 12

Audition for Jazz Yes No

Jazz Instrument Bass or Bass guitar Clarinet Drums Electric guitar Flute French horn Piano Saxophone Trombone Trumpet

Student Email

Student Cell Phone (xxx-xxx-xxxx)

Home Phone (xxx-xxx-xxxx)*

Zip*

Address*

City*

State*

School (2019-2020)*

Are you enrolled in your school music program?** Yes No

School Music Teacher

School Music Teacher Email

Private Music Teacher

Private Music Teacher Email

Parent 1 Name*

Parent 1 Email*

Parent 1 Cell Phone (xxx-xxx-xxxx)*

Parent 1 Occupation

Parent 1 Employer

Parent 2 Name

Parent 2 Email

Parent 2 Occupation

Parent 2 Employer

Parent 2 Cell Phone (xxx-xxx-xxxx)

EMERGENCY CONTACT 1 Name*

EMERGENCY CONTACT 1 Phone (xxx-xxx-xxxx)*

EMERGENCY CONTACT 2 Name

EMERGENCY CONTACT 2 Phone (xxx-xxx-xxxx)

How did you hear about GCTYO?

Please list any allergies your child has.

Please list any medications your child is taking.

Any other information like medical needs or learning style that GCTYO should know about your child.

INSURANCE COMPANY

POLICY NUMBER

Audition dates you are NOT available. If you are a new student and you do not want to audition in June, please put June date as a not available date.

2019 Audition Dates:
NEW STUDENTS ONLY: Wed., June 12 (3 pm – 9 pm).
RETURNING or NEW: Sat., Aug. 24 (9 am– 4 pm) – VIOLINS ONLY. Mon.–Thurs., Aug. 26–Aug. 29 (3 pm – 9 pm) – ALL INSTRUMENTS

AUTHORIZATION: My child has permission to engage in all program activities. I am aware of, and accept, any risk inherent in the program activities. I will inform GCTYO of any special health conditions, including required medication and activity limitations, which should be known to GCTYO staff and/or medical personnel in the event of a medical emergency. I understand that participation in GCTYO requires regular attendance at rehearsals and following GCTYO rules as outlined in the membership handbook, including zero-tolerance for bullying and inappropriate behavior. I understand that GCTYO will send email and/or other communications to the email addresses and phone numbers listed on my registration form.

REPRESENTATIONS: As is inherent in any musical learning or rehearsing environment, there may be limited, incidental and insignificant physical contact between students and/or teaching staff. At no time will a single student ever purposely be alone in a room with any one GCTYO staff adult, with the exception of private instrumental lessons, which will be a 1:1 ratio with no other adults present. Parents are free to sit in on private lessons by request.

PUBLICITY RELEASE: I hereby consent to the use of my child’s likeness (“Likeness”) for the purpose of promotion, publicity, advertising, or other media by GCTYO, or any other representative authorized to act on behalf of GCTYO. Likeness may appear in, but are not limited to, photographs, sound and/or video recordings, films, and broadcasts and may be published in materials such as, but not limited to, brochures, publications, reports, social media (including Facebook, Instagram & Twitter), web pages, promotional materials or any other audio-visual, electronic, printed, tangible work in any media or format, now known or hereafter to become known, and/or reproductions of any of these. I agree that the actual material involved is and shall continue to be the property of GCTYO and that neither I, nor my child, shall have any right of review or approval regarding the use of my child’s Likeness in such material. I hereby release and hold harmless, GCTYO along with their respective employees, agents, affiliates, sponsors, or other representatives from any and all claims, demands, or causes of action arising out of the use of my child’s Likeness, in accordance with the terms of this release. I understand and agree that neither I, nor my child, will be compensated in any way for the use of my child’s Likeness by GCTYO.
If you do not consent to the Publicity release, uncheck this box

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