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CYS Student Information Form
This form must be filled out by every student participating in CYS 2019-2020. The information on this form will not be shared outside of CYS without explicit permission of the student or guardian (if under 18).
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Student First Name
*
Your answer
Student Last Name
*
Your answer
Instrument
*
Your answer
School (please indicate if home schooled)
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Your answer
Grade as of Fall 2019 (please write numerical value ex: 6 not sixth grade)
*
Your answer
Date of Birth
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MM
/
DD
/
YYYY
Student E-mail
Your answer
Student Cell Phone
Your answer
Home Phone
Your answer
Guardian 1 Name
*
Your answer
Guardian Cell Phone
*
Your answer
Guardian E-mail
*
Your answer
Guardian 2 Name
Your answer
Guardian 2 Cell Phone
Your answer
Guardian 2 E-mail
Your answer
Home Address (excluding city and zip code)
*
Your answer
City
*
Your answer
Zip Code
*
Your answer
If there are multiple students in the program from the same family, please fill this form out again for each additional student.
THERE IS A DISCOUNT for each additional student from the same family. Please indicate if you have more than one student in our programs. (The tuition from the higher level groups will be charged at full price if students are in ensembles at two different price points)
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Yes
No
Which ensemble is the student participating in?
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Canton Youth Symphony
Canton Youth Symphony Advanced Orchestra
Canton Youth Strings
Tuition can be paid by check or credit card. There are several payment options. Please read through the options fully!
Canton Youth Symphony and Advanced Orchestra (CYS & CYSAO)
Pay $55 in FULL by 3/16/20 (tuition for remainder of year)
Pay 2 payments of $25 and $30 on 3/16/19; 4/13/20
Discount price for additional student in program - $65 (only applies to families with multiple students in the program and will be added to whatever payment plan was chosen for the first student in the program)
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Canton Youth Strings
Pay $80 in FULL by 9/27/19
Pay 3 payments of $40 on 12/17/19; 2/14/20
Pay 5 payments - $20 on 12/17/19; $15 on the 15th of every month Jan.-Apr.
Discount price for additional student in program - $45 (only applies to families with multiple students in the program and will be added to whatever payment plan was chosen for the first student in the program)
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How will you be paying?
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A) I will pay by check (payable to Canton Symphony Orchestra) on or before the due date
B) Please charge my credit card on the due date
If you selected option B (credit card) please fill out the following information. (information given in this form will not be shared outside of the CSO and will only be used for CYS purposes)
Credit Card #
Your answer
Expiration Date (month and year ex: 4/21)
Your answer
Security Code
Your answer
Electronic Signature (you verify that this information is accurate and was filled out by the person who signed below)
*
Your answer
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