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Palm Beach County Youth Orchestra
2285 Potomac Road,
Boca Raton, FL 33431
www.yopbc.org
2022-23 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
*
M
F
Birth Date
*
+
Relationship to Participant:
*
Self
Mother
Father
Guardian
Other
Other
Primary Contact Name:
*
Primary contact Email:
*
Preferred Phone:
*
Secondary contact: Relationship to Participant:
Self
Mother
Father
Guardian
Other
Other
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)
*
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
School conductor/director name or private teacher (if applicable)
Private teacher email address for invitations to performances
How did you hear about us?
*
Word of mouth
Advertisement (Print media - Radio-Magazines)
Internet
Facebook
Instagram
Other
Other
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
Price below reflects full yearly tuition for the 2022-23 season from September through May. CREDIT CARD PAYMENTS Select below: A Credit Card Convenience Fee $20 added to tuition per musician. To bypass the $20 credit card fee send in a check to our address. YOPBC 2285 Potomac Road Boca Raton, FL 33431
*
Philharmonic Orchestra $720
Symphony Orchestra $720
String Orchestra $720
Training Orchestra $450
Chamber Ensembles $200 + $20.00 cc
Non-refundable administration fee ($20.00)
Current Total:
$0.00
Calculate
CHECK PAYMENTS:
For check payments t
he rates above apply. P
lease 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