Palm Beach County Youth Orchestra
2285 Potomac Road, Boca Raton, FL 33431

2022 REGISTRATION FORM

PLEASE COMPLETE ONE REGISTRATION FOR EACH MUSICIAN

FAMILY INFORMATION

Musician First Name *

Last Name *

YOPBC Member since:

Orchestra:

Instrument *

Address *

City *

State *

Zipcode *

Phone Number *

Musician Email/if applicable

Gender *

Birth Date * +

Relationship to Participant: *

Primary Contact Name: *

Primary contact Email: *

Preferred Phone: *

Secondary contact: Relationship to Participant:

Secondary Contact Name:

Secondary Phone :

Secondary Email:

If Applicable additional mailing address if different from musician's address listed above

Medical Form

Complete, print & bring to first day of season start

SCHOOL/TEACHER INFORMATION

School: *

Grade (year of registration) *

School conductor/director name or private teacher (if applicable)

Private teacher email address for invitations to performances

How did you hear about us? *

Parent/Member acknowledgements:

Release from Concerts (Philharmonic only) *

Musician must be signed out by parents after concerts

Musician may leave without parent consent

By signing this application you agree that:

MEDIA RELEASE: YOPBC may use photos/videos musician for promotional materials such as print, YOPBC website and/or Facebook

RULES & REGULATIONS: I agree to abide by the rules and policies of YPBOC as outlined in the YOPBC Musician Handbook. I understand and agree to the ateendance policy for rehearsals and concerts.

YOPBC reserves the right to terminate my participation if I do not follow the rules and policies in the YOPBC handbook. For more information on the refund policy and other policies please refer to the YOPBC Musician Handbook.

I FULLY UNDERSTAND THE ABOVE YOPBC RULES & POLICIES *

YES

Signature (use your mouse to sign your name) *

clear

Formatted Text

CREDIT CARD PAYMENTS Select below: A Credit Card Convenience Fee $20 added to tuition per musician *

Philharmonic Orchestra $650 + $20

Symphony Orchestra $650 +$20

String Orchestra $650 + $20

Training Orchestra ($400 + $20.00)

Chamber Ensembles ($200 + $20.00)

Non-refundable administration fee ($25.00)

Current Total:

$0.00

CHECK PAYMENTS:

For check payments the rates above apply. Please complete registration by selecting"Continue"

and exclude the $20 Credit Card Convenience Fee in your check amount.

Make check out to: YOPBC

Mail to:

YOPBC

2285, Potomac Rd.,

Boca Raton, FL 33431