2023-24 LYS Registration Please enable JavaScript in your browser to complete this form. - Step 1 of 4Student's Name (as it should appear in the concert program) *FirstLastRegistering for... *Prelude 1 (October-July)Prelude 2 (September-July)Orchestras (September-May)Please select Prelude 1 Class Time *Saturday @ 10amThursday @ 5pmPlease select Prelude 2 Class Time *Saturday @ 11amThursday @ 6pmInstrument *ViolinViolaCelloNon-String InstrumentPlease specify instrument *Who told you about Lakeland Youth Symphony?Student InformationHome Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeHome Phone *TShirt Size *Youth SmallAdult SmallYouth MediumAdult MediumYouth LargeAdult LargeBirthday *Age at Time of Registration *School Attending *Grade in September *Student Contact Info: By listing your child's information, you are giving permission for Lakeland to send him/her important, orchestra-related information.Student EmailStudent Cell PhoneNextPARENT INFORMATIONParent/ Guardian Name (best contact) *FirstLastParent/ Guardian Cell Phone (best contact) *Parent/ Guardian Email (best contact) *must be capable of receiving Lakeland information at this emailPlace of Employment1Parent/ Guardian NameFirstLastParent/ Guardian Cell PhoneParent/ Guardian emailmust be capable of receiving Lakeland information at this emailPlace of Employment2NextEmergency ContactPerson to contact if parent cannot be reached.Name *FirstLastPhone *Relationship to Student *Private TeacherPrivate teachers are required for orchestra enrollment, not Preludes.Private Teacher Name *FirstLastPrivate Teacher Email *Private Teacher Phone *Medical InformationAre there any medical needs of which the Conductor/Instructor should be aware? *YesNoIf yes, please explainAllergies? *YesNoIf yes, please explainDoes the student carry any medications? *YesNoIf yes, please explainNextPARENTAL CONSENTI give my consent and approval for my son/daughter to participate in the Lakeland Youth Symphony. By signing this form, I acknowledge that any activity involves potential for injury. Furthermore, I will not hold The Lakeland Youth Symphony, Lakeland Symphony Society, Inc., the Board of Trustees of the Lakeland Symphony Society, Inc., and/or any independent contractor retained by the Lakeland Symphony Society, Inc. responsible in the event of accident or injury resulting from my child’s participation in the Symphony. As Parent and/or Guardian of the above named participant, a minor, I hereby authorize the treatment by a qualified and licensed medical doctor selected by the Lakeland Youth Symphony (Lakeland Symphony Society, Inc.) in the event of a medical emergency which, in the opinion of the attending physician, may endanger my child’s life, cause disfigurement, physical impairment or undue discomfort if delayed. This authority is granted only after reasonable effort has been made to find me. I also guarantee payment of all charges incurred during this medical treatment (physician, hospital, x-ray, lab, drugs, ambulance, etc.). I hereby give my consent that any videotapes, photographs and/or motion pictures film or audio recordings in which my daughter/son appears may be used by The Lakeland Youth Symphony in their flyers, brochures, and ads including their website. (photo only, not name) I also consent to the use of my cell phone number for the purpose of receiving urgent information in text format from the Lakeland Youth Symphony. Refund Policy1. If a refund is requested before rehearsals start, the refund will be 100% --- 2. If a refund is requested after the first class and prior to October 15th, a 75% refund will be issued.--- 3. If a refund is requested between October 15th and November 30th, a 50% refund will be issued. --- 4. There will be NO refunds after December 1st. --- 5. All refunds will be subject to a $25.00 processing fee. I have read and understand all information on this registration form, including the tuition/fee refund policy *print name to indicate signaturePaymentAfter clicking "Register & Pay" your registration will be saved, and you will be directed to PayPal to pay via credit card. If you prefer to pay via check, simply close the PayPal window and mail your check to LYS, POBox 173, Parsippany, NJ 07054. Please select ensemble for the season *Preludes (September/October-July) - $ 625.00Lakeland Strings (September-May) - $ 650.00Youth Ensemble (September-May) - $ 650.00Lakeland Philharmonia (September-May) - $ 650.00Symphony Orchestra (September-May) - $ 700.00Non-string instruments, please select ensemble for the season *Symphony Orchestra & Wind Symphony (Sept-May) - $ 500.00Coupon Apply Total$ 0.00Register & Pay