Summer Test Registration This form is a test form! 2022 Summer Camp Registration Student DetailsGTCYS wants to get to know your student! Personal demographic information collected in this form (gender, race, etc.) is used for data tracking purposes only, and will have no bearing on the student's summer program placement.Student Name* First Last Student instrument:*Please note: euphoniums are only allowed to participate in Summer Sinfonietta.InstrumentViolinViolaCelloBassFluteOboeClarinetBassoonHornTrumpetEuphoniumTromboneTubaPercussionHarpPlease note: euphoniums are only eligible to participate in Summer Sinfonietta.Grade in 2021-22:*Please list the grade this student was in during the 2021-22 school year (this current year). If the student is homeschooled, select the approximate grade that would fit with their age.Grade123456789101112School in 2021-22:*Please enter the full name of the school this student attended during the 2021-22 school year. Please do not enter an acronym. Student birth date:*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Student gender:* Boy Girl Nonbinary Student pronouns:* He/him She/her They/them Student race/ethnicity*We collect confidential information about students’ race/ethnicity to help measure progress toward GTCYS' diversity and equity goals, inform our programming, and report to philanthropic funders who request it. For this particular purpose, please select the category with which this student most closely identifies. We understand that many students may identify with more than one race or ethnicity. If you are more comfortable, please select “other” and describe the student's race(s). Thank you. White or Caucasian Black or African American Asian or Asian American Hispanic or Latinx Native American or Alaska Native Native Hawaiian or Pacific Islander If you would like to provide any other details about this student's race, please enter it here:For example: -White or Caucasian: If this student is Middle Eastern or Jewish and wishes to specify. -Black or African American: If this student wishes to list a specific diasporic community. -Asian or Asian American: If this student wishes to list a specific community. -Native American or Alaska Native: If this student wishes to list a specific tribal affliation. Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Primary Phone*Please include the primary phone number to contact your family. This should not be a student's cell phone number.Student Email*This will be GTCYS' primary mode of communication with the student. Please enter a valid email. Enter Email Confirm Email Select this student's camp preference*Summer Philharmonia is now full, and we are no longer accepting registrations for that group. Summer Philharmonia (Beginner Strings) Summer Sinfonietta (Developing Strings, Winds, Brass, & Percussion) Summer Symphony (Advanced Strings, Winds, Brass, & Percussion)The summer camp preference you select does not ensure placement in that summer camp. Conductors will make placements based on the musical details you provide and/or your playing sample.SelectSummer SinfoniettaSummer SymphonyPlease note that there are currently very limited openings in Summer Philharmonia. Note: Students who select Summer Sinfonietta or Summer Symphony will be required to submit a playing sample video for placement in these orchestras, due July 1. Students who select these groups will receive instructions about how to submit their videos after completing this registration. Students may be assigned to a camp other than their original preference based on playing level and instrumentation limits. Students who are also auditioning for placement in a 2022-23 GTCYS school year orchestra may submit their audition video for their playing sample.If you wish to be placed with another student or students, please enter their name(s) here:Placement in Summer Camp is based on playing level, and GTCYS cannot guarantee that we can grant these requests, but we will do our best to place students together to honor friendships. Parent/Guardian DetailsParent/Guardian 1 Name* First Last Parent/Guardian 1 Phone*Parent/Guardian 1 Email*This will be GTCYS' primary mode of communication with you. Please enter a valid email. Enter Email Confirm Email Does the student live with two Parents/Guardians?*Clicking yes will allow you to complete information for Parent/Guardian 2. Yes No Parent/Guardian 2 Name* First Last Parent/Guardian 2 Phone*Parent/Guardian 2 Email*This will be GTCYS' primary mode of communication with you. Please enter a valid email. Enter Email Confirm Email Have additional Parent/Guardian information?*Clicking yes will allow you to enter the name and contact information for an additional Parent/Guardian that does not live with the student or lives with the student part time. Yes No Parent/Guardian 3 Name* First Last Parent/Guardian 3 Phone*Parent/Guardian 3 Email*This will be GTCYS' primary mode of communication with you. Please enter a valid email. Enter Email Confirm Email Parent/Guardian 3 AddressEnter parent/guardian 3 address if the student lives with this parent/guardian part time. Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Musical DetailsHow many years has this student played their instrument?*SelectLess than one1234567891011121314Scales known to date (list key and # of octaves)*There are no required scales to be in GTCYS' summer programs; this information helps GTCYS determine the student's placement.Titles and composers of up to three pieces of music this student is currently practicing (please be specific, including arrangers of Suzuki book, if applicable)*This can also include school ensemble music if the student is not working on any solo pieces at this time.Has this student ever been in a GTCYS school year orchestra before?* Yes No If this student participated in a GTCYS school year orchestra in the 2021-22 season, select below:*SelectNoneHarmonyPhilharmonia EastPhilharmonia WestSinfonia EastSinfonia WestConcertino EastConcertino WestCamerataConcert OrchestraPhilharmonicSymphonyHow did you first hear about GTCYS? From a school music teacher From a private music teacher From a friend From a current GTCYS student Online A GTCYS conductor visited my school A GTCYS student made a presentation at my school I attended Open Rehearsal Night I attended a GTCYS concert From a GTCYS parent From a GTCYS summer program From a GTCYS alumni From a GTCYS staff member From a GTCYS advertisement Other Other Source (please describe)* Name of GTCYS staffPlease enter the name of the GTCYS staff member so that we may acknowledge them. Name of GTCYS alumniPlease enter the name of the GTCYS alumni so that we may acknowledge them. Name of GTCYS parentPlease enter the name of the GTCYS parent so that we may acknowledge them. School Music Teacher NamePlease enter the name of the school music teacher so that we may acknowledge them. Private Music Teacher NamePlease enter the name of the private music teacher so that we may acknowledge them. Friend NamePlease enter the name of your friend so that we may acknowledge them. GTCYS Student NamePlease enter the name of the GTCYS student so that we may acknowledge them. Private LessonsTaking lessons with a private music teacher is not required for membership in GTCYS programs, nor does a teacher's status influence summer placement. If this student is taking private lessons, listing their private teacher’s contact information helps us communicate with teachers and keep them informed of orchestra activities and progress.Does this student take private lessons?* Yes No Current Private Teacher Name* First Last Current Private Teacher Email*Please enter a valid email address. If you don't know the private teacher's email address, please enter "none@none.com." 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.Health Insurance CompanyHealth insurance information is not required, but helpful for GTCYS to have on file in case of emergency. Health Insurance Details (ID number, group number, and/or subscriber) Please include the name and phone number of an individual GTCYS can contact if parents/guardians listed above cannot be reached:Emergency Contact Name* First Last Emergency Contact Phone*Emergency Contact Relationship to Student* Food Allergies and Dietary Restrictions*GTCYS will not provide any snacks or other food this summer; however, this information is helpful to have on file in case of emergency. None Peanut Allergy Gluten Allergy Dairy Allergy Other Other (please describe):* Please list all medications that the student requires, including purpose, name, dosage, and frequency. Should any of these be kept with the student? Do any require administration on an emergency basis? If so, describe.*If this does not apply, please enter "none."Please describe any medical conditions including any physical, emotional, behavioral, or mental health conditions. Please be specific.*If this does not apply, please enter "none."Will this student be fully vaccinated by Monday, July 18?*Fully vaccinated means it has been two weeks since receiving the second dose of the Pfizer/Moderna vaccine, or one week since receiving the Janssen vaccine. This information will guide GTCYS’ masking policy and COVID protection protocols for summer programs. Yes No Prefer not to say Please upload proof of vaccination:Please submit a PDF or graphic file of your student's vaccination card. File size cannot exceed 5MB.Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 35 MB.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 GTCYS Summer Camp. I, the parent and/or legal guardian of the student above, wish to have my student participate in GTCYS programs during Summer 2022. 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 2021 – 2022 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. Media DisclaimerBy 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.PaymentNext Step: Summer Program Payment Select ‘Submit’ below and follow the instructions on the next page to pay tuition. If you plan to apply for tuition assistance, you may specify this on the following page. If you exit this page without clicking 'Submit,' your information will be lost. Thank you! PhoneThis field is for validation purposes and should be left unchanged.