You must print this form and bring it to your audition Meremblum Youth Orchestra Application & Registration Date_____/_____/_____ Name____________________________________Birthdate__________Age____Entering Grade_____ Street_______________________________Apt_____City_________________________Zip________ Telephone (____)______-________ Email_______________________________________ Parent(s) Names______________________________________Work Phone (____)______-________ Parent(s) Names______________________________________Work Phone (____)______-________ Emergency Contact Name___________________________________ Phone (____)______-________ Parent's address, if different_____________________________________________________________ Instrument______________________________________Length of Study_______________________ Current Private Teacher_____________________________________Phone (____)______-________ Address_____________________________________________________________Zip____________ Private Teacher's Signature ________________________Email________________________________ Previous Teachers____________________________________________________________________ I also study__________________________________with____________________________________ School______________________________(Check all that apply) Orchestra____Band____Choir____ Music Teacher's Name_______________________________________Phone (____)______-________ Signature of School Music Teacher______________________________________________________ School Address______________________________________________________________________ School District_______________________________________________________________________ Other orchestral training, including music camp, church, community, music honors: ______________________________________________________________when_________________ ______________________________________________________________when_________________ ______________________________________________________________when_________________ Do you participate in another time-consuming activity (eg. sports, scouts, church)? Please identify and contemplate how you will be able to do both: ___________________________________________________________________________________ Do other family members play musical instruments? Name_______________________relationship_______________instrument______________________ Name_______________________relationship_______________instrument______________________ Name_______________________relationship_______________instrument______________________ How did you learn about the Meremblum Orchestras?_______________________________________ Consent is given for the student to appear, without compensation, in television, radio, photographs or other orchestra-related publicity. Student Signature_______________________________ Parent Signature________________________ Complete and bring to your audition with the audition fee of $25.