Registration Form, 2018-2019 Academic Year
This form is required for all returning and recently added Gemini Youth Orchestra members. It is independent of the registration form on the website, which is for PayPal account purposes only. In addition to this form, all parents and guardians are responsible for carefully reviewing and initialing a one-page policy sheet. Both this form and the policy sheet must be completed prior to the first rehearsal in September in order for your child to participate. Thank you.
Student's First Name *
Your answer
Student's Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Age *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Student email
Your answer
Student Mobile Phone
Your answer
New Student? *
Returning Student? *
Number of Years in GYO *
Your answer
Primary Instrument *
Your answer
Secondary Instrument
Your answer
Ensembles (click as many as apply) *
Required
Grade in School as of September 2018 *
Your answer
Parent/Guardian's Names *
Your answer
Home Telephone Number *
Your answer
Parent/Guardian's Mobile Phone *
Your answer
Primary Email (for all communication) *
Your answer
Secondary E-mail Address
Your answer
Emergency Contact Name (if parent cannot be reached) *
Your answer
Emergency Contact Phone Number (if parent cannot be reached) *
Your answer
Physician Name *
Your answer
Physician Phone *
Your answer
Medication (Please list any medication you are currently taking). *
Your answer
Allergies and Other Health Conditions *
Your answer
Years of Study of Your Primary Instrument *
Your answer
NYSSMA Level Completed as of September 2018 *
Score *
Your answer
Private Teacher *
Your answer
Private Teacher Phone *
Your answer
Private Teacher Email
Your answer
Previous Orchestral/Ensemble Experience & Number of Years *
Your answer
How did you hear about the Gemini Youth Orchestras? *
Your answer
During the 2018/2019 academic year, are you participating in other non-school performing groups? (Reminder: Gemini Concert attendance is mandatory) *
If so, name of Orchestra (if not, write "n/a"): *
Your answer
School Student Attends: *
Your answer
School District *
Your answer
School Orchestra/Band Teacher *
Your answer
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