Symphonic Band Registration FormThank you for your interest in the LCMS Symphonic Band Program! Please fill out the form below to register for the 2023-24 season. Registration Information I would like to... * - Select -Pay in full - $327Pay a deposit - $50 (non-refundable)A $50 non-refundable deposit will hold your spot in the program. Would you like to be on an installment plan for payments? * - Select -Yes - $12 surchargeNoPlease note that the Community Music School does not store your credit care information, and installments will not be automatically paid. Are you enrolled in other Community Music School programs for the 2023-24 academic year? * - Select -YesNo ($19 annual registration fee) Student Information First and Last Name * Preferred first name * Gender * Female Male Not Available Birthdate * Year200520062007200820092010201120122013201420152016201720182019202020212022202320242025 Year MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Instrument * Name of School (2023-24 academic year) * Grade (2023-24 academic year) * - Select -7th8th9th10th11th12th Do you study with a private teacher? * - Select -YesNo Private Teacher Name * Curricular Music Verification Students registered for Community Music School ensembles are also expected to participate in a curricular (during the school day) musical ensemble when available. Symphonic Band should not substitute for curricular music programs. I verify that this student is enrolled in curricular music program(s). Curricular music programs are not offered at this student's school/grade level. Curricular Music Verification * Please list the teacher and class name for each curricular ensemble the student is enrolled in for the 2023-24 year. * Parent/Guardian Information First and Last Name * Home Address * City * State * AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * Email Address * Billing and program information will be sent to this email address. Verify Email Address * Phone Number * Format ex. 9205551212 Home Cell Home or cell * Parent/Guardian 2 Information (optional) First and Last Name Is the home address the same as the parent/guardian above? - None -YesNo Home Address * City * State * AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * Email Address Program information will be sent to this email address. Verify Email Address Phone Number Format ex. 9205551212 Home Cell Home or Cell Ensemble T-Shirt Symphonic Band T-Shirt All Symphonic Band students receive a gray t-shirt, which is included in the price of tuition. Shirts feature the Community Music School logo on the front and the Lawrence Community Bands graphic on the back, the color is TBD. T-shirts will be distributed at rehearsal in the fall. Click here to view a size chart. T-Shirt Size * - Select -Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult X-Large Parent/Guardian Volunteering The Community Music School is looking for parent/guardian volunteers to help with events during the year. Please select your preferred options below if you are interested in volunteering. I would like to volunteer for... Concert poster distribution Concerts - taking tickets and handing out programs Emergency Contact The emergency contact cannot be the parent/guardian previously listed. In the event of an emergency, the parent/guardian listed above will be contacted first; the name below will be used only if the parent/guardian cannot be reached. First and Last Name * Relationship to Student * Phone Number * Health Information Please list any allergies, medications, asthma, diabetes, epilepsy, seizures, etc. Please put N/A if there are no concerns. * Does your child have any learning or behavioral needs? * Yes No If so, please list needs or accommodations: * Electronic Signature Of Parent or Legal Guardian * Type your name here to sign and confirm the emergency contact and health information. Community Music School Guidelines Registration in a Community Music School program indicates understanding and acceptance of our guidelines. Acknowledgement * By checking this box, I agree to follow all Community Music School guidelines and accept responsibility for all charges and fees that are incurred. Assumption of Risk and Release of Liability This document affects your legal rights - read it carefully. I am registering for a Program of the Lawrence Community Music School during the program year July 2023-June 2024. I acknowledge that the Program is voluntary and may involve certain risks, including those described below. I understand that the Program involves, among other activities, rehearsing, performing, engaging in recreation, and, if applicable, traveling off campus. I acknowledge that these activities present certain inherent risks beyond Lawrence University’s control. I choose to participate in the Program understanding its associated risks, and I knowingly and voluntarily assume all risks of injury, illness, death, or damage to or loss of my property that may occur while rehearsing, performing, traveling, engaging in recreation, or any activities arising out of or related to the Program. My participation in the Program is voluntary, and I understand that I may discontinue my participation at any time in light of the risks I am assuming. I hereby forever release Lawrence University, its trustees, officers, employees, and agents (the “Released Parties”), from liability for any negligent act or omission arising from my participation in the Program, including related costs, damages, claims, or assertions to which I or my family, estate, or heirs may claim against the Released Parties. This Assumption of Risk and Release of Liability shall be construed in accordance with the laws of the State of Wisconsin, which shall be the forum for any lawsuits filed under or incident to this Release or the Program. Acknowledgement * By checking this box I agree to the Assumption of Risk and Release of Liability. How did you hear about the Lawrence Community Music School? * CAPTCHA This question is included to prevent automated spam submissions; it is not presented to logged-in users. 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