Registration Forms

General Information

Musician's Name

First Name

Last Name

Musician's Email Address

Musician's Cell Phone

(###)

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Instrument

Please select all ensembles you will join from your acceptance list

Select all that apply

Chamber Orchestra

Symphony Orchestra

Concert Orchestra

String Orchestra

Preparatory Orchestra

Senior Flute Ensemble

Junior Flute Ensemble

Wind Ensemble

Jazz Ensemble

Current School

Current Grade in School

Parent Information

Parent 1 Name

First Name

Last Name

Parent 1 Email

Parent 1 Cell Phone

(###)

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Parent 2 Name

First Name

Last Name

Parent 2 Email

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Employment

Some grant opportunities require us to identify members of our organization who are connected to the grantor (such as FedEx, Starbucks, BGE, to provide examples). Please list place(s) of employment for parents or guardians and/or organizations that may offer grant opportunities (Rotary, VFW, Etc)

Race / Ethnicity

Many grants are asking us to indicate the ethnicity of our members. This information will help us respond accurately to future grants. Which race or ethnicity best describes you? (Please choose only one.)

Emergency and Medical Information

Name of Musician

First Name

Last Name

Emergency Contact Information

Name of Parent/Guardian

First Name

Last Name

Parent/Guardian Email

Parent/Guardian Phone

Please provide your most reliable phone number.

(###)

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Emergency Contact #2 Name

First Name

Last Name

Emergency Contact #2 Phone

(###)

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Emergency Contact #3 Name

First Name

Last Name

Emergency Contact #3 Phone

(###)

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Medical Information

Allergies or other health information

Please share ANY information necessary to make your musicians's experience safe and positive.

Current Medications

Doctor's Name

First Name

Last Name

Doctor's Number

(###)

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Emergency Treatment Permission

In the event that a parent or guardian is unreachable, CYSO personnel or representatives of the CYSO will seek emergency medical treatment for my child. I understand that any expense will be billed to me or my insurance carrier.

enter your initials in the box below

Date

MM

DD

YYYY

Permission for Publicity

Name of Musician

First Name

Last Name

Name of Parent

First Name

Last Name

Permission

I give the Chesapeake Youth Symphony Orchestra (CYSO) permission to use photographs, videos, and/or audio recordings of the student named above in orchestral, ensemble, or other CYSO events appears for publicity materials. I understand that such appearances of this student in photographs, videos, and/or audio recordings will occur without compensation, and I understand that any such photographs, videos, recordings, or promotional materials are the sole property of the CYSO, Inc.

Musician Contract

Name of Musician

First Name

Last Name

Agreement

I commit to abide by the the CYSO policies as detailed in the Student Portal. I understand that the CYSO maintains professional standards of musicianship and conduct, and I will live up to those standards. I commit to prepare for and attend rehearsals and concerts of the CYSO Orchestra of which I am a member. I understand that more than three (3) unexcused absences are grounds for dismissal. Furthermore, I will not consume alcohol, tobacco, or other drugs while at any CYSO rehearsal or sponsored event. Further, I will cooperate with my peers in the teamwork necessary to build an ensemble of the highest standards of musical accomplishment. I will remain loyal to previous commitments to school, community, and teachers, remembering that these continue to contribute to my achievements.

Date

MM

DD

YYYY

General Release Form

In consideration of acceptance and participation in the Chesapeake Youth Symphony Orchestra, Inc. (hereinafter referred to as “CYSO”) the undersigned and/or his/her parents and/or guardians hereby release the CYSO, its agents, officers, directors, servants and/or employees of and from any and all liability, claims, damages, actions and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the undersigned as well as damage to any property of the undersigned, at any time during their participation in the CYSO including all rehearsals, performances, trips, or other events in which the undersigned participates by virtue of membership in the CYSO. The parents or guardians do further consent and agree that neither they nor the undersigned, individually or as parent or guardian of a minor will ever institute any suit, action at law, or make any claim against CYSO, its agents, officers, directors, servants and/or employees, for or by reason of any damage, loss or injury either to person or property or both, which the undersigned or their parents or guardians now have or hereafter shall have by reason of any matter, cause or thing arising out of participation in the CYSO. In further consideration of the undersigned participation in the CYSO, the undersigned and their parents and/or guardians agree to indemnify and save harmless the CYSO, its officers, directors, agents, servants and/or employees against any claim for damages, compensation or otherwise on the part of the undersigned or their heirs, executors, administrators or personal representatives, and to reimburse the CYSO for any loss, damages or costs, including reasonable attorney’s fees that the CYSO may have to pay if any litigation arises on account of any claim made by or on behalf of the undersigned. The undersigned further grants to CYSO, its agents, officers, directors, servants and/or employees full authorization to take such action as they deem necessary or appropriate to protect the health and safety of the undersigned, including at the sole discretion of the CYSO and the undersigned sole expense, placing the undersigned under the care of a doctor or hospital at any place for examination and/or treatment.

Name of Guardian or Musician over 18

First Name

Last Name

Agreement

We certify that we have read the foregoing general release. IN WITNESS WHEREOF, I have affixed my signature.

Guardian or Musician over 18 Submitting your name here constitutes signing this agreement.

Today's Date

MM

DD

YYYY

CYSO Bullying Policy

Make A Bullying Report

The Chesapeake Youth Symphony (CYSO) is committed to affording all of our members the highest value musical education and performance experience as possible. To this end, our mission is to provide a safe and welcoming environment for all of our students. We respect our students’ varied backgrounds and the life experiences they bring to our organization and similarly expect our students to respect each other and the artistic staff of CYSO. Therefore, any actions or behaviors to the contrary are completely counter to our mission and our efforts to provide quality experiences for our students.

Effective immediately, CYSO has established guides that we will follow for incidences of bullying. As drawn from a Maryland Department of Education policy, “bullying, harassment and intimidation mean any intentional conduct, including verbal, physical or written conduct, [or shunning], or an intentional electronic communication, that creates a hostile … environment by substantially interfering with a student's … benefits, opportunities or performance, or with a student's physical or psychological well-being. The conduct must (1) be motivated by an actual or a perceived personal characteristic including race, national origin, marital status, sex, sexual orientation, gender identity, religion, ancestry, physical attributes, socioeconomic status, familial status, or physical or mental ability or disability, or (2) be threatening or seriously intimidating. Electronic communication means communication transmitted by means of electronic device, including a telephone, cellular phone, computer and pager.” (The full policy can be found here)

Any CYSO student experiencing bullying during a CYSO rehearsal period, performance, or travel under CYSO auspices, or any parent/guardian learning of same, should report the event to the student’s CYSO ensemble manager and complete the form below. If the ensemble personnel manager observes what appears to be bullying, s/he should also complete the form. The manager will report the incident to the Executive Director immediately after being notified by the student or after personal observation and submit the form to the Executive Director within 24 hours. The Executive Director with the Ensemble Manager and or Conductor will do the following:

Meet individually with the victim in the presence of his/her parent
Verify the bullying with witnesses
Meet with perpetrator(s) and parent(s) to include the victim if deemed appropriate in order to mediate a dispute if there is an ongoing problem

If there is a second incidence of bullying after mediation, the Executive Director will report the situation, and submit documentation, to the CYSO Board, which may consider suspension of the offender for the remainder of the current semester or permanent expulsion from CYSO to include a forfeiture of tuition.

Name of Musician

First Name

Last Name

Name of Parent or Guardian of Musician under 18

First Name

Last Name

Agreement

We certify that we have read the foregoing CYSO Bullying Policy. IN WITNESS WHEREOF, I have affixed my signature.

Guardian or Musician over 18 Submitting your initials here constitutes signing this agreement.

Today's Date

MM

DD

YYYY

Registration Forms

Registration for all musicians

General Information

Emergency and Medical Information

Permission for Publicity

Musician Contract

General Release Form

CYSO Bullying Policy