Summer Program Registration

I 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.

1. 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.

After 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.