ASCYO Membership Information
Please fill out this form completely and submit by Tuesday, September 19th.
First Name
Your answer
Middle Name
Your answer
Last Name
Your answer
Date of Birth
MM
/
DD
/
YYYY
Gender
Your answer
Primary Instrument
Secondary Instrument
Your answer
School
Write "Home School" if you do not attend a public or private school
Your answer
Grade in the 2017/18 School Year
Senior Bio (only complete if you will be a senior this year)
All high school seniors are required to write a personal profile for the upcoming Fall and Spring Program. The profiles should be a short paragraph, written in the third person. Please include information such as: primary instrument and length of time playing instrument, plans for the future (immediate and long term), thank you to those who have strongly influenced your life, when you joined ASCYO and your impressions of your experience in the group, interests and hobbies, and high school awards and honors.
Your answer
Race
Street Address
Your answer
Apartment Number
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
County
Your answer
Student Email
Your answer
Primary Student Phone
Your answer
Secondary Student Phone
Your answer
Parent Name
Your answer
Second Parent Name
Your answer
Primary Parent Email
Your answer
Secondary Parent Email
Your answer
Primary Parent Phone
Your answer
Secondary Parent Phone
Your answer
Parent Volunteer
Required
Private Teacher Name (if applicable)
Your answer
Private Teacher Phone (if applicable)
Your answer
Private Teacher Email (if applicable)
Your answer
School Orchestra/Band Teacher Name (if applicable)
Your answer
Acknowledgment of Privacy Statement
The Academy of Saint Cecilia Youth Orchestra (ASCYO) collects this information for the following purposes: 1. to administer the membership of the ASCYO; 2. to apply for grants and other sources of funding from federal, state, local and private sources; 3. to publish programs in support of ASCYO concerts. This information will not be shared with outside parties beyond these stated uses, and under no circumstances will an individual member's information be supplied to a third party without their prior consent; however by participating in the Academy of Saint Cecilia ensembles, you hereby authorize and consent to the publication of the member's name in materials intended for distribution in support of Orchestra concerts, including but not limited to programs, posters, and flyers.
Acknowledgement of Use of Personal Likeness Provision
The Academy of Saint Cecilia Youth Orchestra (ASCYO) will display or publish photographs and images on its website, in newsletters, visual media and other publications to promote events, institutes, and other purposes which benefit ASCYO. Under no circumstances will an individual member's personal information be published in connection with a photograph or image without their prior consent; however by participating in the Academy of Saint Cecilia ensembles, you hereby authorize and consent to the display of the member's personal likeness, without compensation, on the website as well as in newsletters, visual media and other publications intended for viewing by or distribution to the public in support of ASCYO.
Acknowledgement of Email Notification Policy
By providing an Email address above, the member is requesting information be provided by the Academy of Saint Cecilia Youth Orchestra through email. By providing an Email address for the parent, the owner of that email address is likewise requesting information be provided by the Academy of Saint Cecilia Youth Orchestra through email. Email addresses will be treated as private information subject to the above Privacy Statement.
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