Santa Fe Youth Symphony Association 2022-2023 Student Registration Form

Health and Medical Information

Please type "N/A" for any question that does not apply to this student.
Emergency Contact: Parents cannot be emergency contact *

First Name Last Name
Emergency Contact Relationship to Student *
Emergency Contact Phone *
Please enter a valid phone number.
Student Food Allergies
Student Medicinal Allergies
Other Allergies
Medical Alerts/Notices
Doctor's Name *

First Name Last Name
Doctor's Phone *
Please enter a valid phone number.
Health Insurance Provider *
Group Number *
Member Number
Volunteering
Family Volunteer Requirements *
SFYSA strives to provide the highest quality music education at an affordable rate. However, tuition covers 33% of costs and SFYSA depends on the service of families to assist with necessary fundraisers, concerts and other special events.We require each family to provide 5 hours of volunteer service during the season. There are many activities that take place, so there is something for everyone! We appreciate your help.Please select yes to show that you understand.
Volunteering Interest
Release and Waivers
Permission to Participate *
As the parent/Guardian, I hereby give permission for this student to participate in the programs and activities of the Santa Fe Youth Symphony Association including rehearsals, performances, tours, retreats, and fundraising activities. I certify my understanding that, as a result of the current ongoing Coronavirus (COVID-19) pandemic, participation in face-to-face gatherings of any kind, and specifically gatherings in which playing instruments are involved, participation is potentially hazardous to my and/or my student's health. I hereby release SFYSA from any and all claims, damages, or other liabilities which may be asserted as a result of the students participation in the activity, or any injury, loss, damage, or incident occurring during such participation.
Health/Emergency Consent *
I agree that the Santa Fe Youth Symphony Association may obtain medical attention, advice, evaluation, or treatment for my child in an emergency while participating in SFYSA events. In case of emergency, I understand that reasonable efforts will be made by SFYSA to contact me. In the event of an emergency, I agree to pay for any medical services that might be needed beyond that provided by my insurance. I hereby give my permission for the administration of over-the-counter medications by a SFYSA staff member. I agree and understand that the Santa Fe Youth Symphony Association has sole discretion to determine when such an emergency has occurred.
Parent/Guardian Obligations *
As a parent/guardian of a SFYSA member, I realize my obligation to the SFYSA and my student member. I will keep current with my financial and service obligations. I will make sure that my student's SFYSA schedule is followed and that he/she is a contributing member of the organization. I further understand that excessive absences and tardies, inappropriate behavior, and unfulfilled obligations both musical and financial will be cause for dismissal from the SFYSA. I will pay for damage to music or property, if any that occurs is a result of my student's behavior. As a parent of a student in this ensemble, I agree to have my student(s) at the dress rehearsals and performances.
Financial Commitment *
Please check the box to indicate your understanding that you are assuming a financial obligation and that you are solely responsible for making sure tuition is paid.
Image and Video Release *
As part of our outreach and funding reports we may take photographs and vidoes of our children in action as they participate in classes, rehearsals, fundraisers, and concerts. We also post images and video on our website and social media. Please indicate if you give your consent for us to use your child's image for these purposes.

	Quantity
Youth XS (Children's size 2-4)
Youth S (Children's size 6-8)
Youth M (Children's size 10-12)
Youth L (Children's size 14-16)
Youth XL (Children's size 18-20)
Adult S
Adult M
Adult L
Adult XL
Adult XXL

Credit Card Details - for initial payment only (recurring payment information will be collected below)
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

SFYSA 2022-2023 Student Registration

PAYMENT BY MONTH

Please fill out one form for each child that you are registering

Student Information

Ensemble Selection

Student Education Information

Household Information

Health and Medical Information

Volunteering

Release and Waivers

Monthly Payments

Recurring Payment

Recurring Payment Enrollment Agreement