2023-24 GTCYS Student Enrollment Form Please fill out the enrollment form below. 1Student and Family Details2Tuition Payment Options Student DetailsStudent Name* First Last Student Email*If not applicable, please enter none@none.com Enter Email Confirm Email Nickname/preferred name: Select the student's instrument:*SelectViolinViolaCelloBassFluteOboeClarinetBassoonHornTrumpetTromboneEuphoniumTubaPercussionHarp2023-24 School Orchestra Director Name*If not known or not applicable, please enter NA for both first and last name. First Last 2023-24 School Orchestra Director Email*If not known or not applicable, please enter none@none.com 2023-24 School Band Director Name*If not known or not applicable, please enter NA for both first and last name. First Last 2023-24 School Band Director Email*If not known or not applicable, please enter none@none.com Student Directory*Share a fun fact about this student to include in the student directory (ie. a hobby or interest outside of music or a special skill) Please upload this student's photo for the student directoryThe photo should not exceed 5MB and must be in one of the following formats: .jpg, .jpeg .png, Please make sure the photo shows the student's face. This photo will only be used to help students, conductors, and staff get to know the faces and names of the students in their orchestra. This photo will not be shared with any other parties. If you have trouble uploading a photo, please email it to katie@gtcys.org and include the student's name, instrument, and orchestra.Accepted file types: jpg, jpeg, png, Max. file size: 5 MB.Parent/Guardian DetailsParent/Guardian 1 Name* First Last Parent/Guardian 1 Email* Enter Email Confirm Email Parent/Guardian 1 Employer Please consider listing your professional information which helps us identify parents’/guardians' areas of expertise for volunteering and special projects. It also can help us connect with the business community for PR initiatives and fundraising activities, including matching gift programs, sponsorships, and grants which GTCYS pursues to sustain our programs. Your information is never shared with third parties.Position Is Parent/Guardian 1 a GTCYS alum?* Yes No Student Lives with Two Parents/Guardians*(Checking "Yes" will allow you to add information for Parent/Guardian 2.) Yes No Parent/Guardian 2 Name* First Last Parent/Guardian 2 Email* Enter Email Confirm Email Parent/Guardian 2 Employer Please consider listing your professional information which helps us identify parents’/guardians' areas of expertise for volunteering and special projects. It also can help us connect with the business community for PR initiatives and fundraising activities, including matching gift programs, sponsorships, and grants which GTCYS pursues to sustain our programs. Your information is never shared with third parties.Position Is Parent/Guardian 2 a GTCYS alum?* Yes No Have Additional Parent/Guardian AddressIf you need to enter the name and contact information for an additional parent/guardian that does not live with the student, please select "yes" here. Yes No Relationship to Student* Parent/Guardian 3 Name* First Last Parent/Guardian 3 Email* Enter Email Confirm Email Parent/Guardian 3 Employer Please consider listing your professional information which helps us identify parents’/guardians' areas of expertise for volunteering and special projects. It also can help us connect with the business community for PR initiatives and fundraising activities, including matching gift programs, sponsorships, and grants which GTCYS pursues to sustain our programs. Your information is never shared with third parties.Position Optional: Mailing List ReferralHelp us expand our concert audience by referring grandparents, friends, or other family members to GTCYS. We will add referrals to our mailing list and keep them informed of your student's GTCYS activities. Thank you!Would you like to add a family member or friend to the mailing list?* Yes No Name First Last Relationship to Student 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 Preferred Email Enter Email Confirm Email Have additional individuals to add?If you want to enter the name and contact information for an additional individual, please select "yes" here. Yes No Name First Last Relationship to Student 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 Preferred Email 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 InformationPlease 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:*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 else we should know about this student to help us create an optimal learning environment for them?Emergency contact, if parents/guardians cannot be reached (required)Emergency Contact Name*Please list a different contact from the parents/guardians listed above. First Last Relationship to student* Emergency Contact Cell Phone*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: Permission 1* 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. Permission 2* 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.). Permission 3* 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. Media Information and Code of ConductBy 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.GTCYS will send out a carpool directory before the beginning of the semester. This directory includes addresses and primary parent emails. Please click below if you wish to be included in this carpool directory.* YES, please include my family in the carpool directory NO, I would like to OPT OUT of the carpool directory 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 2023 – 2024 GTCYS Season. I, the parent and/or legal guardian of the student above, wish to have my student participate in GTCYS programs during the 2023 – 2024 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 2023 – 2024 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. Payment OptionsGTCYS offers a sibling tuition discount in the amount of $75 per additional child enrolled (second sibling, third, etc.). You can now apply this discount when you pay in full or pay in monthly installments. You will be prompted to enter this information on the next page if you select to pay with credit card. If applying for tuition assistance, please select Apply for Tuition Assistance below to learn more about assistance options for your family.How would you like to pay tuition?* Pay in Full with Credit Card Pay in Full with Check Set Up Monthly Payments Apply for Tuition Assistance Defer Enrollment to January This student accepts their placement in GTCYS for the 2023-24 season in:* Philharmonia East Philharmonia West Sinfonia East Sinfonia West Concertino East Concertino West Camerata Concert Orchestra Philharmonic Symphony Is this student planning on attending the 2024 Symphony Tour to France and Spain?* Yes No Unsure You will be directed to pay a $20 on the next page to hold your spot for January 2024.Please make your check out to GTCYS and mail it to the GTCYS office by July 14. Tuition amounts are listed on the next page.Please have your credit card information ready. You will be directed to pay on the next page.Please click "Submit" below. Please pay a $20 tuition deposit on the next page, and then you will be redirected to apply for tuition assistance.PhoneThis field is for validation purposes and should be left unchanged.