STEAMBOAT SPRINGS ORCHESTRA
YOUTH PROGRAM
REGISTRATION FORM, 2007-08 Season
Student’s Name:
___________________________________________________________________________
Last First
Primary Address:
Name(s) of Parent(s) or Guardian________________________________________________________
Last First
______________________________________________________________________
Mailing Address
Phone Numbers: Home: (______)_______________________Cell: (______)_____________________
Email will be the primary means of communication. Please list an email checked frequently and
print the email address clearly: ______________________________________________________
Student’s E-Mail__________________________________________________
Secondary Address (to be filled out if parents are separated or divorced)
Name of parent______________________________________________________
Last First
______________________________________________________________________
Mailing Address
Phone Numbers: Home: (______)_______________________Cell: (______)_____________________
E-Mail:________________________________________
Grandparent (or other) addresses, to add to our mailing list:
Relationship to participant Relationship to participant
Name Name
Address Address
City/State/Zip City/State/Zip
Phone Phone
E-Mail E-Mail
Parents’ Employment Information:
Father: __________________________________ Mother: _______________________________
Occupation Occupation
__________________________________ ________________________________
Employer’s Name Employer’s Name
__________________________________ ________________________________
Street Address Street Address
__________________________________ ________________________________
City State Zip City State Zip
__________________________________ ________________________________
Work Phone # Fax Work Phone # Fax
SSO YOUTH PROGRAM REGISTRATION FORM, 2007-08 Season
(Continued)
Student’s Age: ___________ Date of Birth: ____________ Grade (2006-2007)_____________
Student’s School: ____________________________ School Phone #_______________________________
School Music Director’s Name:_________________________________________________________
Instrument(s): ___________________________________________________Years of Study: __________
Private Teacher’s Name: _______________________________________Phone #: _____________________
Teacher’s Email:_______________________________________________
Ensemble / Orchestra Placement Information – Please attach a copy of the student’s last polished music piece.
If Suzuki, simply indicate the current book & piece (i.e. Suzuki, Book 3, Piece #7):
________________________________________________________________________
The following information is essential for forming Chamber Ensembles.
Please be accurate and complete. Attach additional notes if necessary.
If applying for orchestra only, please do not fill out this section.
Orchestra rehearsals will be from 4:15 – 5:45 on Mondays!
Student Availability - Please indicate regular times your student musician can attend weekly rehearsals during
the school year:
M __________________________ T ________________________
W __________________________ Th __________________________ F _______________________
If rehearsals are held immediately after your child’s school-day at their school, are these times effected?
__________________________________________________________________________________
List any weeks your child will not be available for rehearsals during the school year:
_____________________________________________________
NOTE: The Youth Program Performances will be on Dec. 10, March 3, & May 18 at 7 pm.
Participation is MANDATORY for all students in an ensemble!
Photo Release (Must be signed by parent):
I grant permission to Steamboat Springs Orchestra to use photos, film or electronic forms of media of my child
for use in publicity, promotion, grants, web sites, film or other media without notifying me. I waive any right to
inspect or approve the photos, film, or electronic matter that may be used with them now or in the future, known
or unknown to me, and I waive any right to compensation from such use.
I have read this release before signing below, and I fully understand the contents. I understand that I am free to
address any specific questions regarding this release by submitting those questions in writing to SSO, and I
agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this
release.
Parent’s signature:__________________________________________________Date:________________
Payment: Registration ($25 per family) $____ Orchestra Fee ($500) $_____ Ensemble Fee ($600) $____
Donation $_____
Total Enclosed$_____________
Payment is due in full with your registration. Payment plans may be arranged if necessary,
by emailing the SSO office at info@steamboatorchestra.org or by phone at 879-9008, ext. 107.
Financial aid, based on need, is available for qualified participants. Contact the SSO office
for further information and a Financial Aid Form. Payments are returned if your child
cannot be placed in an Ensemble Group.