2012-13 SYSA Enrollment Form Parent/Guardian name ________________________________________________ Musician name __________________________ Instrument__________________ Orchestra (circle): Mozart Players/ Amadeus Players/ Philharmonia/ Youth Symphony To enroll: Mail to SYSA, P.O. Box 1113, Salem, OR 97308 or bring to rehearsal 1. 2. 3. 4.

Player Profile complete with all information IF not previously submitted. $25 nonrefundable enrollment fee for each member, check payable to SYSA Emergency Contact and Medical Release (printable from website) Enrollment form (this page) www.salemyouthsymphony.org

Tuition payment options Mozart Players - $100 per term ($200 year), Amadeus Players - $280 year Philharmonia and Youth Symphony - $300 year ___ I will pay tuition in FULL at the beginning of the season. (Preferred) ___ I will pay tuition in TWO installments: by Oct. 15 and Feb. 15 ___ I will pay tuition in FOUR installments: Oct. 15, Nov. 15, Feb. 15, Mar. 15 ___ I will submit a Tuition Assistance Application before October 5, 2012 (registration fee not covered; see SYSA website under “Auditions/Tuition”) ___ Tuition choices are listed on handbook form for your reference. Checks payable to SYSA, P.O. Box 1113, Salem, OR, 97308 The Handbook ____ I have read the Handbook (2 pages, available online) ____ I understand that virtually all communication will be by email and and posted on the website. I will check these regularly. ____ I do not have email but will be responsible to keep informed. Volunteer Options ____ I will provide at least 2 hours of volunteer work for each SYSA musician. ____ I prefer to make a donation of $50 per year instead. Tax deductible. Signature for tuition, handbook, volunteer options _______________________________ Email (please print clearly) _________________________________________________ Photo/Video release The Salem Youth Symphony often takes photos of our activities and events. Videos of the concert are usually available for purchase. ____ I agree to allow SYSA to use photos/videos of my child for promotional use. Signature of parent/guardian ________________________________Date ____________ ____ I am over 18 years of age and agree to allow SYSA to use photos/videos of me for promotional use. Signature _______________________________________________ Date _____________