2025 Midsummer Music Madness Registration Form

Midsummer Music Madness Registration June 16-20 & June 23-27, 2025 (9:00am - 12:30pm)

Please remember that your registration is not complete until we receive your registration fee. Fees can be paid online at www.fgbyo.com or mailed to FGBYO Box 91103 Lake Charles, LA 70609.
Student Information
Student's Name*

First NameLast Name
Address*

Street Address

CityState / Province

Postal / Zip Code
Age*
Grade*
School*
T-Shirt Size
Does your child know how to read music?*
ViolinCelloViolaGuitarPianoMy child plays none of these instruments
Does your child have any of the above instruments available for personal use during summer camp? If so, please list them.

Students are asked to choose one primary instrument, and are allowed up to two elective instruments to enjoy during camp. Please indicate your child's interest by selecting their 1st, 2nd, 3rd, 4th choice, etc. Please note that instruments are limited and classes will be assigned on a first come, first serve basis, so your first choice may not always be possible.*

Rows	1st Choice	2nd Choice	3rd Choice	4th Choice
Violin
Cello
Viola
Guitar
Piano
Ensemble
Theory

Parent/Guardian Information
Name*

First NameLast Name
Relationship*
Best Contact Number*
Format: (000) 000-0000.
E-mail*
example@example.com
Does the student have any allergies, chronic illness, or medical conditions that we should be aware of? If yes, please describe.
Emergency Information
Additional Emergency Contact*

First NameLast Name
Relationship*
Phone Number*
Format: (000) 000-0000.
Media Release

I give the Dr. Francis G. Bulber Youth Orchestra permission to include my child in various media related productions. These may include Facebook, adverstisements, newspaper articles/photos, recruitment pamphlets/fliers/brochures, local television interviews/filming (individually or with a group), and/or FGBYO's own webpage. I hereby give the Dr. Francis G. Bulber Youth Orchestra, Inc. permission to use my child's
Yes, I give my permission to use my child's name.
Yes, I give my permission to use my child's photo.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date*

MonthDayYear
Date
Name of Person Registering Student*
Registration Fee of $300 for FGBYO Members and $350 for Non-Members

Please remember that your registration is not complete until we receive your registration fee. Fees can be paid online at www.fgbyo.com under the "Summer Camp" heading or mailed to FGBYO Box 91103 Lake Charles, LA 70609
Should be Empty:

Midsummer Music Madness Registration June 16-20 & June 23-27, 2025 (9:00am - 12:30pm)

Student Information

Media Release

Registration Fee of $300 for FGBYO Members and $350 for Non-Members