Please fill out the following information for your child. You may register now, or wait until schools and class times are confirmed. Check back often for updated lists! Contact Information Student's First Name * Student's Last Name * Date of Birth * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1997199819992000200120022003200420052006200720082009201020112012201320142015 Gender * Male Female Grade * - Select -3rd4th5th6th in 2017-2018 Your Child's School Name * Home Address * Home City * Home Zip Code * Parent/Guardian First * Parent/Guardian Last * Parent/Guardian Email * Home Phone (xxx) xxx-xxxx Cell Phone (xxx) xxx-xxxx Please select class site * - Select -BaywoodBishop's PeakC. L. SmithDel MarDorothea LangeHawthorneLos RanchosMonarch GroveSinsheimerSt. Patrick'sVineyard Demographic Information These optional questions help by giving us information we use for grants and other applications. Parent/Guardian(s) place of employment & occupation Primary language used at home Medical Information and Releases Emergency Contact Name * Emergency Contact Phone * Emergency Contact's Relationship to Student * Primary Physician Name Primary Physician Phone Number Health Insurance Provider Health Insurance Policy # Please list any pertinent medical conditions or serious allergies MEDICAL RELEASE: * I accept. MEDICAL RELEASE: I (We) the parent(s)/guardian(s) of the above named minor, give my (our) permission for my (our) child to participate in the San Luis Obispo Symphony's Strings in the Schools (SIS) and assume all risks and hazards incidental thereto, including those arising in the course of transportation to and from SIS functions. I (We) hereby give consent and authorize proper authorities of the SIS to administer first aid, authorize necessary emergency treatment at a nearby emergency medical facility, and/or authorize a medical doctor to examine or treat the child for illness or injury or both while he/she is in attendance with SIS or on related activities. By selecting the "Accept" you are agreeing to the terms above. Agreements MEDIA RELEASE: * I Accept. I give my permission for the use of any Strings in the Schools related photographs, videos, or audio recordings of my child for promotional and social media purposes. By selecting the "Accept" you are agreeing to the terms above. Clicking on "Submit" will take you to the payment page. If you will be requesting a scholarship application, please make a $50 payment under "Grant Commitment Fee". If you will be making partial payments on tuition, please use "Strings in the Schools PARTIAL PAYMENT". Scholarship information is available on the Strings in the Schools webpage. In order to reserve a spot for your child in this program, a minimum commitment fee of $50 must be made.