CYO Annual Registration
Please fill out all fields to the best of your ability. If you have questions please call or email our General Manager: civicyouthorchestra@gmail.com / 760-728-1977
Student Full Name
*
First Name
Middle Name
Last Name
Ensemble you participate in
*
Please Select
Prelude
Prelude / Intermezzo
Intermezzo / Intermediate
Intermediate / Chamber
Wind Ensemble
Symphonic Orchestra
Symphony Orchestra
Instruments You Play in CYO (list all)
*
Student Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Student Email Address
*
example@example.com
Student Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Student Date of Birth
*
-
Month
-
Day
Year
Date
School Student Attends and Grade Level
*
Student T-Shirt Size:
*
Adult - Small
Adult - Medium
Adult - Large
Adult - XL
Adult - 2XL
Private Music Teacher Name (explain if you do not have one)
*
Private Teacher Contact Information (Phone, Email, Street Address)
*
Back
Next
Parent / Legal Guardian 1 Information
Enter the information for the first parent or legal guardian
Parent / Legal Guardian 1 - Name
*
First Name
Middle Name
Last Name
Is Address the same as the Student's address?
*
Yes
No
Parent / Legal Guardian 1 - Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Parent / Legal Guardian 1 - Employer, Address, Phone
Parent / Legal Guardian 1 - Email
*
example@example.com
Parent / Legal Guardian 1 - Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Back
Next
Parent / Legal Guardian 2 Information
Enter the information for the second parent or legal guardian
Parent / Legal Guardian 2 - Name
*
First Name
Middle Name
Last Name
Is address the same as the Student's address
*
Yes
No
Parent / Legal Guardian 2 - Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Parent / Legal Guardian 2 - Employer, Address, Phone
Parent / Legal Guardian 2 - Email
*
example@example.com
Parent / Legal Guardian 2 - Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Back
Next
Emergency Contact Information
Not parent or guardian. Parent/Guardian will always be called first
Emergency Contact 1 - Name
*
First Name
Last Name
Emergency Contact 1 - Relationship to Student
*
Emergency Contact 1 - Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact 2 - Name
*
First Name
Last Name
Emergency Contact 2 - Relationship To Student
*
Emergency Contact 2 - Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Submit
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