2011-2012 SYSA Enrollment Form Parent/Guardian name ________________________________________________ Musician name __________________________ Instrument__________________ Orchestra (circle): Amadeus Players Philharmonia Youth Symphony To enroll: Mail to SYSA, P.O. Box 1113, Salem, OR 97308 or bring to rehearsal. 1. Player Profile complete with all information IF not previously submitted. 2. $25 nonrefundable enrollment fee for each member, check payable to SYSA 3. Emergency Contact and Medical Release (also printable from SYSA website) 4. Enrollment form (also printable from SYSA website) Tuition payment options Amadeus Players - $250; Philharmonia and Youth Symphony - $270 Siblings receive a $50 discount ($25 for one term) ___ I will pay tuition in FULL at the beginning of the season. (Preferred) ___ I will pay tuition in TWO installments: by Oct. 15 and Feb. 15 ___ I will pay tuition in FOUR installments: Oct. 15, Nov. 15, Feb. 15, Mar. 15 ___ I will submit a Tuition Assistance Application before October 4 (see SYSA website under enrollment forms; registration fee not included) ___ I have marked this tuition choice on my handbook form as a record. Checks payable to SYSA, P.O. Box 1113, Salem, OR, 97308 The Handbook ____ I have read the Handbook (2 pages, available online) ____ I understand that virtually all communication will be by email and and posted on the website. I will check these regularly. Volunteer Options ____ I will provide at least 2 hours of volunteer work for each SYSA musician. ____ I prefer to make a donation of $50 per year instead. Tax deductible. Signature for tuition, handbook, volunteer options _______________________________ Email (please print clearly) _________________________________________________ Photo/Video release The Salem Youth Symphony often takes photos of our activities and events. Videos of the concert are usually available for purchase. ____ I agree to allow SYSA to use photos/videos of my child for promotional use. Signature of parent/guardian ________________________________Date ____________ ____ I am over 18 years of age and agree to allow SYSA to use photos/videos of me for promotional use. Signature _______________________________________________ Date _____________

Fall, 2011 The information gathered on this form will be used for grant writing and reporting purposes only. Grants often require this information from us. The questions follow the U.S. Dept of Education guidelines for Race/Ethnicity questions on 2010-2011 surveys. Thank you! 1.) Are you Hispanic or Latino?  Yes, Hispanic or Latino (including Spain)  No, not Hispanic or Latino 2.) Regardless of your answer to the previous question, please select one or more of the following with which you identify:     

American Indian or Alaskan Native Asian (including Indian subcontinent and Philippines) Black or African American Native Hawaiian or Other Pacific Islander White