Symphony Strings

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Symphony Strings

2021-2022 Registration Form

Student Information

Student name (First & Last) *

Birthday *

YYYY

School attended *

Classroom Teacher *

I would like to play: *

Violin

Viola

Cello

Do you have an instrument *

I have an instrument

I will rent an instrument

I need to check out an instrument from OES's lending library

Parent/Guardian Contact

Parent/guardian name *

Address (Street, City, State, Zip) *

Primary phone number *

Email address *

Alternative Family Contact

Alternative family contact name *

Alternative family contact phone *

Alternative family contact address (Street, City State, Zip) *

Alternative family contact email *

Registration Fee

Registration for Symphony Strings 2021-2022 is $50 for the full year. Need based financial assistance is available. Please pay what you are able in order to ensure that our funds help as many students as possible. OES staff will contact you regarding processing payment. Registration will not be considered complete until payment is settled.

I will pay *

Full Registration Fee $50

I am applying for financial assistance

Amount of financial assistance requested

Parental Permission and Medical Release

Submitting this registration form signifies permission for your student to attend the Oregon East Symphony’s/Pendleton School District's Symphony Strings activity. You also give my permission for program staff, a nurse, or health center or hospital staff to administer any aid immediately to your student should they become sick or injured while attending, and to do so without having to wait until you are contacted. You also agree to hold harmless the Oregon East Symphony, and the program staff for any injury incurred by my student as a direct or indirect result of my student’s participation in the program. You also consent to photographs of your student engaging in Symphony Strings to be used for Oregon East Symphony related publications and promotional material.

Insurance Company *

Policy / Group # *

Medical Conditions / Allergies *

Physician Name & Phone # *

Demographic Survey (optional)

The following is for grant reporting purposes and assists OES in procuring foundational support for its educational programing. Answering is optional.

What race does your student identify as?

American Indian / Alaska Native

Asian

Black / African American

Native Hawaiian / Pacific Islander

White

Other:

Clear selection

What ethnicity does your student identify as?

Hispanic

Non-hispanic

Clear selection

Does your student qualify for free or reduced price lunch?

Yes

Clear selection

Submit

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