Longy Sistema Side by Side 2017-18 Seminario Series Registration Form

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This registration form will help us collect information needed for the logistics of the Side by Side series this year, as well as to assist us in caring for your child during these rehearsals and concerts.

Student's First Name *

Student's Last Name *

Age *

Primary Instrument *

Parts will be assigned based on the need of each ensemble.

Years of experience *

Please indicate the ensemble you are registering for: *

Ensemble assignments will be determined based on the level of each student and the need of each ensemble.

Wind Ensemble (Wind and Brass students with 1-3 years of experience)

String Orchestra (String students with 1-3 years of experience)

Advanced Symphony Orchestra (String, Wind, Brass and Percussion students with 4-8 years of experience)

Current El Sistema program you are representing *

Primary Music Teacher

T-Shirt Size *

Child S

Child M

Child L

Adult S

Adult M

Adult L

Adult XL

Other:

Please indicate any Food Allergies: *

Parent's Prefix

Mr.

Mrs.

Ms.

Other:

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Parent's Last Name *

Parent's First Name *

Address

City

State

Zipcode

Home Phone

Cell Phone #1 *

Cell Phone #2

Email address *

Emergency Contact Name *

We will attempt to contact the parent(s) at the above numbers first. If no answer, this will be the next point of contact.

Emergency Contact's Relationship *

Emergency Contact's Phone Number *

IPEDS Ethnicity Questionnaire *

When applying for grants and funding for its music programs, Longy is frequently asked to supply information regarding the ethnicity and race of students participating in the program. We are required to use the following ethnicity/race categories when completing the reports, so we ask each student to complete BOTH questions below (Please note that categories were not determined by Longy, but were determined by the Department of Education).

Hispanic or Latino

Not Hispanic or Latino

IPEDS Race Questionnaire *

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Other:

If you want to register a second child into the program, please select "yes" below.

Yes

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