Youth Registration Fee

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How are you (the purchaser) related to the student?

Student Information

First Name:

Last Name:

Gender:

Date of Birth:

Name of School: (if applicable)

Grade for 2023-2024 School Year:

Nickname:

Please select your t-shirt size:

Instrument:

Length of time played:

Current music teacher:

Parent/Guardian Information

Name

Address

City

Country

State/Prov

Postal Code

Relationship to Student:

Primary Phone Number:

Primary Email for all class communication:

Second Parent/Guardian Information (If applicable)

Name:

Does the Second Guardian reside at the same address as the Primary Guardian?

Second guardian's Phone Number:

Second guardian's email address:

Relationship to Student:

Emergency Contact Information

Emergency Contact Name:

Emergency Contact Phone: Please provide any notes for us:

Relationship to Student:

Medical Information

Physician Name:

Physician Phone Number:

If your child has SEVERE allergies that we should be aware of, please list them below. If you plan to leave an Epipen during class times, please indicate below.

Does the student regularly take any medications that we should know about? If yes, please list below. If no, please write 'none'.

Are there any accommodations that Bay Chamber can make to support the learning experience of your child?

Waiver

MEDIA RELEASE: Unless informed otherwise in writing, Bay Chamber Concerts and Music School may use student photos, video footage and student quotes in print and electronic publications, on social media, and in media coverage of Bay Chamber Concerts and Music School programs. I acknowledge that Bay Chamber Concerts and Music School takes cautionary steps to provide minimum identifying information.

Yes I understand and accept the above Media Waiver.

MEDICAL WAIVER: In the event of serious illness or injury, I authorize the staff of Bay Chamber Concerts and Music School to act as my agent in obtaining medical care for the student(s) listed on this form. I understand that I will be contacted using the information I have provided above.

Yes I understand and accept the Medical Waiver.

How did you hear about this class?:

Would you be willing to volunteer at Music School events or provide occasional administrative support?

I have read, understand, and accept all of the Bay Chamber Concerts and Music School Class Policies and Procedures and am aware that they are strictly upheld by Bay Chamber Concerts and Music School.

Yes I agree.

Available Groups

Available Sections

Registration Fee $50.00

Registration Fee $50.00

Student Information

Parent/Guardian Information

Second Parent/Guardian Information (If applicable)

Emergency Contact Information

Medical Information

Waiver

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Item details

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Quantity for General Admission

Registration Fee $50.00

Quantity

Registration Fee $50.00

Additional items

Student Information

Parent/Guardian Information

Second Parent/Guardian Information (If applicable)

Emergency Contact Information

Medical Information

Waiver