BIAD String Dreams Registration Form

1
Student Name* This field is required.
First Name
Last Name
2
Student Email* This field is required.Personal email preferred. School email is okay if you don't have a personal email.
example@example.com
3
Student Phone Number* This field is required.Please add your parent's phone number, if you don't have one. You will also receive an invitation to join our Remind text communications.
Area Code
Phone Number
4
Address* This field is required.
Street Address
Street Address Line 2
City
State
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
5
School Name * This field is required.
6
Grade Level* This field is required.
5th or younger
6th
7th
8th
9th
10th
11th
12th
7
Music Teacher/Director Name OPTIONAL: Please provide the name of your music teacher at school. If you are not in a music class at school, please provide the name of a private music instructor.
First Name
Last Name
8
Primary Instrument* This field is required.
Violin
Viola
Cello
Bass
Other
9
IF you play the Violin, what part do you normally play?ONLY for Violins.
1st
2nd
3rd
Mix of parts
10
Instrument Access* This field is required.
I have my own instrument.
I have an instrument through b-Instrumental.
I have an instrument from school.
Other
11
IF you play Cello or Bass, are you able to transport your own instrument to rehearsals and the concert?ONLY for Cellos and Basses. Do you have a vehicle with capacity to transport your large instrument?
Yes
No, I will need help with transportation (or borrowing an instrument).
12
T-Shirt Size* This field is required.Please select unisex t-shirt size for the EMTO event.
S
M
L
XL
2XL
3XL
13
Date of Birth* This field is required.
14
Gender* This field is required.For demographic purposes only.
Female (she/her)
Non-binary (they/them)
Male (he/him)
Other
15
Race/Ethnicity* This field is required.For demographic purposes only.
American Indian / Alaska Native
Asian
Black / African American
Hispanic / Latino
Native Hawaiian / Other Pacific Islander
White / Caucasian
Mixed / Multiracial
Other
16
Annual Household Income* This field is required.CONFIDENTIAL - For grant purposes only.
Less than $15,000
$15,000 - $24,999
$25,000 - $34,999
$35,000 - $49,999
$50,000 - $74,999
$75,000 - $99,999
$100,000 or more
Not Sure
17
Does the student have any intellectual, developmental, or physical disability?* This field is required.CONFIDENTIAL - For grant purposes only.
Yes
No
Not Sure
18
If Yes, please specify.CONFIDENTIAL - For grant purposes and/or any necessary accommodations.
19
Please list any medical conditions/allergies.CONFIDENTIAL - For medical emergency purposes only.
20
Please list any preferred hospital.CONFIDENTIAL - In case of medical emergency.
21
Parent/Guardian Name* This field is required.
First Name
Last Name
22
Parent/Guardian Phone Number* This field is required.NOTE: Parent/guardian will be considered Emergency Contact by default. If you would like to add an additional emergency contact, please list name, phone number, and relation to the individual in the Message section of this form. Your parent will also receive an invitation to join our Remind text communications.
Area Code
Phone Number
23
Parent/Guardian Email
24
Is your Parent/Guardian interested in volunteering at any BIAD rehearsals or BIAD concert?* This field is required.
Yes
No
Maybe - need more information
25
How did you hear about BIAD?* This field is required.
Colleen Phillips
Social Media
A Friend or Family Member
School
26
MessageOPTIONAL: Please share any additional thoughts or questions you have.
Should be Empty: