Ensemble 1 BRAVURACONCERTJAZZ1JAZZ2PERCUSSIONPRINCIPALSTRINGSYMPHONYWIND

Ensemble 2 BRAVURACONCERTJAZZ1JAZZ2PERCUSSIONPRINCIPALSTRINGSYMPHONYWIND

Ensemble Fee1

Ensemble Fee2

Snack Fee

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

Retreat Fee

Sibling Discount

Total Due

Comment

Total Amount Received

Withdraw Amount

Update record for ,. RegisterId:

Student Last Name*

Student First Name*

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

Grade (2020-2021)* 4 5 6 7 8 9 10 11 12

Interested in Jazz or Steel Pan Yes No

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

Student Email

Student Cell Phone (xxx-xxx-xxxx)

Home Phone (xxx-xxx-xxxx)*

Zip*

Address*

City*

State*

School (2020-2021)*

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 Information:
Auditions will be recorded this year. Auditions are to be submitted between August 19th and August 29th. New students will submit their recordings via email. Returning students should submit their recordings to the Google Classroom “Auditions” using their GCTYO student emails.
We will send instructions after we receive your registration form.
Everyone who plans to participate in our program either in person or virtually needs to submit an audition, unless you choose to participate in our Steel Pan ensemble.

If you do not consent to the Publicity release, uncheck this box

Clicking the Submit button below indicates you have read and understand the information in this box. 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.

Submit