Music Camp Registration

Prescott Youth Orchestra

Music Camp Registration
General Information Questions
Student's Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent or Guardian Name*

First NameLast Name
Phone Number (If Different)
Please enter a valid phone number.
Email (If Different)
example@example.com

Music Questions

Please Note: An instrument will be provided if necessary and included in the tuition.
What instrument will you play at Music Camp, and how long have you played? (It's fine to be a beginner!)*
Will you be bringing a playable instrument?*

YesNo
If applicable, what other instruments do you play and how long have you played?
Do you take lessons from a private music instructor?*

YesNo
If YES, what is his/her name?

First NameLast Name
School Name and Grade you will be attending in the Fall*
Tell us about your music experience? (short statement)*
What would you like to do with your music? (short statement)*
Personal Questions
Any allergies we should know about?*
Any medical conditions we should know about?*
Emergency Medical Contact #1*
Emergency Medical Contact #2*
Emergency Medical Contact #1 Phone*
Please enter a valid phone number.
Emergency Medical Contact #2 Phone*
Please enter a valid phone number.
What size T-Shirt do you wear?*

All The Legalese...

Parent/Guardian Registration Authorization, Waiver and Consent Form
AUTHORIZATION AND ACKNOWLEDGEMENT: By signing this waiver and consent, I, the legal parent/guardian grant permission for my child to participate in any and all activities at the Prescott Youth Orchestra Music Camp. I acknowledge that the possession or use of alcoholic beverages and illegal drugs are strictly forbidden. I understand the possession of any weapon (firearm, knife, explosives, etc.) is strictly forbidden. I authorize the Prescott Symphony Orchestra/Prescott Youth Orchestra, its officers, directors, employees, agents, and representatives (hereinafter referred to as PSO) to release my demographic information to supporting affiliates who help with the cost of my child attending camp.I agree to release and hold harmless the PSO from any and all injury claims of any other nature which may result from my child’s participation in the Music Camp. I agree to indemnify and hold the PSO and other children in attendance at Music Camp harmless from any and all liability caused by myself/my children, whether or not intentional.

Medical Consent: The PSO will make every effort to contact me in the case of an emergency. I give my permission for the PSO staff to administer any medications needed and to provide and arrange for any necessary medical treatment to my child while at the PYO Music Camp, including onsite and offsite emergency care. I accept responsibility for the costs of all such medical treatment.

COVID-19: In consideration of myself and my child/student, I/we, and any legal representatives, heirs and assigns, hereby release, waive, and discharge PSO from all liability for any loss or damage, and any claim or damages resulting therefrom, on account of any injury, illness or exposure to and/or contracting the coronavirus (COVID-19) or other biological agents, virus or similar bacteriological agent by me or my child in attendance at and participation in the PYO MUSIC CAMP, including any medical expenses, injury and/or death. I agree to indemnify PSO from any loss, liability, damage, or cost that may be incurred due to my child's participation in the aforementioned program, whether caused by the negligence of PSO or otherwise. I fully understand, on my behalf, and behalf of my child/student the risks associated with the aforementioned participation and assume any risk associated therewith.

Photography Release: In consideration of my child’s participation at PYO MUSIC CAMP, and without any further consideration from PSO, I hereby grant permission to PSO, staff and affiliates to utilize my child's appearance, performance or voice in any and all manner and media throughout the world for the purpose of promotion, reporting or publication. The PSO may use my child's name, likeness, voice and biographical material in connection with publication, promotion, exhibition and distribution of such material. I understand that no royalty, fee or any other compensation of any kind shall become payable to me by reason of such release and use of any photograph.

SPECIAL NOTE: Care and consideration will be given when it involves publicity of minor children. We at PSO most often only use images of musicians, both adult and youth in promotion of the orchestras, and restrict any personal information from the public.

QUESTIONS: Contact Joe Cotten at (928) 925-4687.

I have read this form carefully and have had all questions answered before signing this legal document and giving the consents and waivers contained in it. I acknowledge that this is a legal document and I will be bound by my agreement to its terms. I represent to PSO that all information provided is accurate and complete and that I have the legal authority to provide consent on behalf of my child.
Signature

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Prescott Youth Orchestra

All The Legalese...