Musician's Information

Musician's First Name *

Musician's Last Name *

Musician's Email Address *

Musician's Instrument *

Musician's High School Graduation Year *

Musician's School

Musician's Twitter Account (If Applicable)

PARENT INFORMATION

Parent One's First Name *

Parent One's Last Name *

Parent One's Email Address *

Parent One's Address *

Parent One's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent One's Occupation *

Parent Two's First Name

Parent Two's Last Name

Parent Two's Email Address

Musical Mentors

Musician's Private Instructor Name *

Musician's Private Instructor Name

First Name

Last Name

Musician's Orchestra/Band Conductor's Name *

Musician's Orchestra/Band Conductor's Name

First Name

Last Name

LEGAL

Media Release *

1. I hereby allow my child to participate upon my own initiative and application and assume all risks of his or her participation in the Contemporary Youth Orchestra. In consideration of her/his participation in said program, I do hereby waive and release all claims arising as a result of personal injuries or property loss during such program, except claims due to willful and malicious gross negligence, against the CYO, its officers, agents, trustees, and members, and further hereby agree that no suit of action of law shall be instituted for the above reason by me or others, including my child. 2. I hereby consent to and authorize the use and reproduction by CYO of any and all recordings, photographs and other audiovisual materials taken of my child or containing the performances of my child, or pictures or other reproductions of myself attending CYO events, for promotional material, educational activities or for any other use for the benefit of CYO, including commercial activities, all without any compensation to me or my child. I waive any claim for damages associated with the preceding, including claims based on a right of privacy, false light invasion of privacy, public disclosure of private facts, false endorsement, infringement of a copyright or trademark, and/or based on false designation of origin, false endorsement and/or defamation. I expressly waive any right to inspect or approve the finished product incorporating my (or child’s) image, likeness, and performances. This consent and release will be binding upon me and my heirs, legal representatives, successors, and assigns.

I agree

Medical Release *

I hereby consent, during my absence, for all medical and/or surgical treatment and/or special procedures which may be required during our absence. Without in any manner limiting the foregoing appointment and authorization, if circumstances permit, I would like to have our doctor consulted in connection with such medical and/or surgical treatment and/or special procedures.

I agree

UNIFORM

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