Performance Ensemble Registration Form

Is the member under 18 years of age?(Required)

Yes

Member Information

*Youth member info to be filled out by parent or guardian

First Name(Required)

Last Name(Required)

Date of Birth(Required)

Phone(Required)

Email(Required)

Contact Information

Street Address(Required)

City(Required)

Province(Required)

Postal Code(Required)

Parent/Guardian Contact Information

Parent/Guardian #1 Name(Required)

Parent/Guardian #1 Phone(Required)

Parent/Guardian #1 Email Address(Required)

Parent/Guardian #2 Name

Parent/Guardian #2 Phone

Parent/Guardian #2 Email Address

Emergency Contact

Emergency Contact Name(Required)

Emergency Contact Phone #(Required)

Emergency Contact Email(Required)

Music History

What instrument do you play?(Required)

How many years have you played?(Required)

Liability Consent

It is expressly understood and agreed that I am participating with the Grande Prairie Music Society entirely at my own risk and that neither Myself nor my executors, assignees, heirs or representatives will hold the Grande Prairie Music Society, its Executive, their agents or other band members responsible for any death, injury, loss or damage occasioned to my person or property during the course of rehearsal, performance, and associated activities, however same may be caused whether with or without negligence on the part of any person and whether such occurs during band planned activities or during free time. I hereby acknowledge and agree that the Grande Prairie Music Society and its Executive, do not assume any responsibility for loss of wages, or the cost of medical, dental or hospital care incurred by band members participating.

I agree to the above terms & conditions(Required)

I agree

Photo Consent

Throughout the season, photos may be taken of the band and its individual members. Some of these photos may be used for advertising and promotional purposes including the Grande Prairie Music Society's website and Facebook page. Pictures of the whole band in performance will be posted without signed permission; there will be no names posted with photos. Close-ups, individual or candid shots, will not be posted without your permission. Please let us know your wishes regarding photos of you.

Photo Consent(Required)

Yes, I allow individual photos to be posted.

No, I do not allow individual photos to be posted.

Fees

Fees are as follows:

All Groups:

$10 (Yearly Individual Society Membership Fee - only pay once per year)
$125 / Session

Payment may be sent by EFT to admin@gpmusicsociety.com (please put the name of the member in the comment) by cash or by cheque made out to Grande Prairie Music Society.

Please indicate which ensemble(s) you are registering for:(Required)

Jazz Band

Orchestra

Wind Ensemble

Youth Orchestra

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