Harmony Registration 2022-2023 2022-2023 Harmony Registration English Student Registration for 2022-2023 Harmony ProgramPlease fill out the information below to apply to Harmony for the 2022-2023 academic year. Harmony is an exciting cello and violin program with openings for up to 75 students, including first-time participants in grades 2-5 and returning Harmony students from last year. • Returning Harmony students are guaranteed a spot and will continue their same instrument. • New students are eligible for cello or violin and may indicate their preference below. We will do our best to honor students’ instrument preferences, but violin openings will be offered to 2nd and 3rd graders first, then to 4th/5th graders if space allows. • If instrument classes reach capacity, we will start a waitlist and add students if openings become available.Student Name* First Last Has your student played in Harmony before?*YesNoGrade in 2022-23:*Please list the grade your student will be in during the 2022-23 school year. Grade2345 Attention 5th Grade Families 5th graders who are joining us as first year students should be prepared to dedicate extra time and energy to their instrument. This is to ensure that they are prepared to join GTCYS upon graduation from Riverview! Student age* What instrument is your student interested in?*Note: Selecting an instrument below only indicates your child's instrument preference. We will confirm your child's instrument at orientation night. ViolinCelloUndecidedSelect student race*We collect confidential information about students’ race to help inform our programming, report to philanthropic funders who request it, and measure progress toward GTCYS’ diversity and equity goals. For this particular purpose, please select the category with which you most closely identify. We understand that many students may identify with more than one race. If you are more comfortable, please select “other” and describe your race(s). Thank you. White or Caucasian Black or African American Hispanic or Latinx Asian or Asian American Native American If you would like to provide any other details about your student's race, please enter it here: Student birth date:*MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Select your gender*FemaleMaleNonbinaryTransgenderPrefer not to saySelect your pronouns:* He/him She/her They/them Who is your student's classroom teacher?*Ms. WandaMrs. PabonMs. WeningerMs. AndreMs. JohnsonMrs. KelloggMs. ArroyoMrs. RodriguezMs. WilsonMs. MMs. NelsonMs. RiveraNot sureOtherOther Parent/Guardian DetailsParent/Guardian 1 Name* First Last Parent/Guardian 1 Phone*Parent/Guardian 1 Email*Harmony will be using email as a primary mode of communication with you. Please enter an email that you regularly check. Enter Email Confirm Email Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Does the student live with two Parents/Guardians?*Clicking yes will allow you to complete information for Parent/Guardian 2.YesNoParent/Guardian 2 Name* First Last Parent/Guardian 2 Phone*Parent/Guardian 2 Email*Harmony will be using email as a primary mode of communication with you. Please enter an email that you regularly check. Enter Email Confirm Email Medical Information & Emergency ContactThis information is required to support the health and safety of GTCYS students at all GTCYS activities, and it will be kept confidential. Please be forthright. Disclosing complete and accurate information is in your student's best interest so we can support their success in GTCYS.Student Medical Information*Please describe any medical conditions including any physical, emotional, behavioral, or mental health conditions. Please be specific and transparent so we can better support your student.*Is this student taking any medication?* Yes No Please list all medications, including the purpose, dosage, frequency, and times when the student requires medication. Should any of these be kept with the student? Do any require administration on an emergency basis?**Does this student have any allergies (medications, insect bites, food allergies)?* Yes No Please list allergies (medications, insect bites, food allergies), triggers, and typical reaction: (If none, write N/A)*Please check any dietary restrictions or preferences that this student has:* Gluten-free/gluten intolerant Dairy-free Vegetarian Vegan Kosher Halal Other None Other dietary restriction/preference:* Is there anything more that we should know about this student to help us create an optimal learning environment for them? (If nothing, then say none).* Emergency Contact*Please enter a contact who is different from your parent/guardian 1 and 2. First Last Relationship to Student* Emergency Contact Phone number*Parent/Guardian Medical ConsentName of authorized parent or guardian completing this consent form:* First Last Please check the following boxes to signify your agreement to these statements:* I give my permission for the student named above to participate in GTCYS, which comprises a range of rehearsals, performances and social events. I understand that there may be times when illness or accident may occur, requiring immediate medical attention, and that it may not be possible to contact me immediately. I give my general consent to the administration of minor first aid to the student to deal with matters of comfort or convenience and not requiring the attendance of medical personnel (e.g. cleaning a minor cut or scrape, providing over the counter medicine, etc.). In the event of an emergency, I authorize GTCYS to make arrangements for professional medical and surgical care for my child/ward without my prior approval. I understand that I will be notified by the quickest means possible if this authority is exercised. I also agree to accept financial responsibility for charges in excess of those covered by my health insurance. TransportationBecause SPPS cannot provide bus transportation for Harmony at this time, participating families will need to use other means (walk, drive, carpool) to get to Harmony by 7:50am on Tuesdays, Wednesdays, and Thursdays starting October 25 – late May. Please answer the following questions about your transportation situation so we can do our best to help you. Please answer the following questions about your transportation needs so we can do our best to find a transportation solution for you starting this fall. Will a member of your household or another individual be able to drive your student to Harmony in the mornings?*(Program begins at 8:00am sharp, students are expected to arrive at 7:50am on Tuesdays, Wednesdays, and Thursdays. Breakfast will be served after Harmony). Yes, I or someone I know will be able to driveUncertain - I will have to look at my optionsNo, that is not possible for my familyWe will send out a carpool directory at the beginning of the school year to help families connect about rides. This directory includes addresses and primary parent emails. Please click below if you wish to be included in this carpool directory.*Note: you will also have time during orientation night to connect with other families about carpooling. YES, please include my family in the carpool directory NO, I would like to OPT OUT of the carpool directory Other information about your studentIs your child an English learner?* What language do you speak at home?* Student Interest*Learning to play a musical instrument is fun and rewarding, but also requires hard work. Tell us why you want to play a musical instrument. (You may ask your child this, and write down their response here).Parent Commitment*Parental success and involvement is also important in a child's success in learning a musical instrument. Please tell us why you would like to see your child participate in Harmony, and how you will support his/her musical education (practice at home, take care of instrument, attend concerts, volunteer, etc.)Release and Indemnification Agreement*THIS RELEASE AND INDEMNIFICATION AGREEMENT (the “Agreement”) is entered into between me and the Greater Twin Cities Youth Symphonies (“GTCYS”) in connection with the 2022 – 2023 GTCYS Season. I, the parent and/or legal guardian of the student above, wish to have my student participate in GTCYS programs during the 2022 – 2023 academic year. I acknowledge that although GTCYS is taking steps to promote the health and safety of students, there are still risks of having my student participate, including the risk of contracting and spreading COVID-19. I have been given sufficient opportunity to ask questions and obtain information about the programs and measures being taken to promote health and safety. I understand that my student is free to withdraw from participation at any time. My contact information is included in this form. I, the parent and/or guardian, agree that at my sole cost and expense, I will release and indemnify, protect and hold GTCYS harmless against and from any and all damages, losses, liabilities, obligations, claims, costs and expenses (including, without limitation, attorney fees and court costs) of any kind or any nature whatsoever arising in whole or in part out of my child’s participation in GTCYS during the 2022 – 2023 season. I enter into this Agreement without reservation of any kind except for liabilities arising out of any intentional wrongful acts on the part of GTCYS, its directors and employees. This Agreement shall be binding upon the parent(s) or guardian(s) whose signature(s) appear(s) below and their respective assigns, and inures to the benefit of GTCYS, and its successors and assigns. This Agreement shall in all respects be governed by, and construed and enforced in accordance with, the laws of the State of Minnesota. Media Information and Code of Conduct By participating in GTCYS, you give permission for your student's name and likeness to be used in any print, digital, or other promotional materials created by GTCYS or its program partners.Instrument Loan Agreement*Students have the opportunity to take their instruments home part way through the year (or at the beginning, if they are already enrolled in Philharmonia). These instruments are very valuable both as musical instruments and as tools for learning. Taking home an instrument for practice at home can be fun and helpful to your learning, but you must remember the rules for proper instrument care and ownership. Please review the rules for instrument care with your student, and indicate your agreement and understanding by checking the boxes and by signing your name at the bottom. I agree to the following rules: Do not leave your instrument in the car. Do not leave your instrument anyplace where it will experience extremes of temperature or in high traffic areas where cracking or damage may occur. Do not allow anyone but you or your parents or guardians to handle your instrument. Contact your teacher if any damage happens to ensure a quick fix for future classes. I agree that the instrument loaned to my child is properly cared for. In case of loss or damage to the instrument while in the possession of my child, I further agree to pay for the repair and/or replacement of the instrument. I am not comfortable accepting responsibility for my child's instrument, and would prefer that they leave it at school. Student e-signature* Parent e-signature* Date* MM slash DD slash YYYY Next Step: Harmony recommended participation fee To finish registering, press ‘Submit’ below and follow the instructions on the Harmony recommended participation fee. If you are unable to pay the fee at this time, you may specify this on the following page. If you exit this page without clicking 'Submit,' your information will be lost. You must complete the following page for us to receive your registration! Thank you! CommentsThis field is for validation purposes and should be left unchanged.
