Elementary Strings Registration 2015

To register for Elementary Strings (ES) for 2015-2016, please fill out the following form and submit it. Also, see the payment information below.

Registration Form

Student Contact Information - Información de Contacto (estudiante)

Student First Name - Primer Nombre de Estudiante

Student Last Name - Apellido de Estudiante

Home Phone - Número de Teléfono

Address - Dirección Postal

City - Ciudad

Zip Code - Código Postal

School (in 2017-2018 school year) - Escuela (año 2017-2018)

Grade (in 2017-2018 school year) - Grado

Class Room Teacher Name - Nombre de Maestro/Maestra

Parent/Guardian Contact Information - Información de Contacto (padre/guardián)

Parent/Guardian First Name - Primer Nombre

Parent/Guardian Last Name - Apellido

Parent/Guardian Cell/Work Phone - Número de Teléfono

Parent/Guardian Email Address - Correo Electrónico

Second Parent/Guardian First Name - Primer Nombre (segundo padre/guardián, opcional)

Second Parent/Guardian Last Name - Apellido (segundo padre/guardián, opcional)

Second Parent/Guardian Cell/Work Phone - Número de Teléfono (segundo padre/guardián, opcional)

Second Parent/Guardian Email Address - Correo Electrónico (segundo padre/guardián, opcional)

Emergency Contact Information - Información de Contacto Emergente

Emergency Contact - Nombre

Relationship of Emergency Contact - Relación al Estudiante

Emergency phone number - Número de Teléfono

Elementary Strings Class Information - Preferencias de Orquesta

Level - Nivel
Level 1Level 2Level 2 Advanced

Preferred ES Class Location (Elementary School) - Primaria/Ubicación Preferida

Instrument - Instrumento Preferido

Additional Student Information - Información Adicional

Please provide information about such things as food allergies, learning styles, sensory/motor processing or visual/hearing impairments. Favor incluir información acerca de alergias, modos de aprendizaje, o discapacidad sensorial, motor, visual, o auditiva (éste no pesa en contra de la aplicación).

Photo Release - Permiso de Foto

Permission is granted for my child to appear in ES publicity photos and/or videos. Doy permiso de que mi niño/a aparezca en fotos/videos de publicidad CYSA.

YesNo

Commitment Policy - Acuerdo de Compromiso

ES requires a 3-month commitment from each student. Afterwards, if a family wishes to withdraw from ES, a parent or guardian may contact CYSA by email or phone. One month’s notice is required at time of withdrawal. La Orquesta Primaria pide compromiso de 3 meses para cada estudiante. Después si la familia prefiere retirar del programa, el padre/guardián puede contactar a CYSA por teléfono o correo electrónico. Preaviso de un mes requerido al momento de retiro.

I understand and agree to the above commitment policy and payment requirements. - Yo entiendo y estoy de acuerdo con el Acuerdo de Compromiso y los requisitos de pago

Behavioral Expectation Policy - Acuerdo de Expectativo Comportamiento

I understand and agree to the ES Behavior Expectations - Estoy de acuerdo con el Acuerdo de Expectativo Comportamiento. The policy is shown here - accesible por el sitio Web o en la oficina CYSA.

Additional message if any - Información Adicional (opcional)

Electronic Authorization - Firma/Autorización Electrónica

Please certify that you are a parent or legal guardian of the student being registered by typing your name in the box below. Favor certifique que usted es padre o guardián legal del estudiante registrado, por entrar su nombre aquí.

If you are a human, please enter this code below - Para verificar que usted es human, favor entra el código siguiente: captcha

Please click “Send” above to make sure that the registration is completed before continuing below to make a payment.

Payment Plans

We accept Paypal, VISA and MasterCard, checks, and cash. Please make checks payable to CYSA. If mailing, send check or charge information to:

Elementary Strings
Corvallis Youth Symphony Association
PO Box 857
Corvallis, OR 97339
For Paypal, please use the form at the bottom of this page.

Please choose one of the following options; a $15 registration fee is in addition to selected payment plan.

  • Option 1: One payment of $365 due 10/10/2015, including $15 registration fee.
  • Option 2: 8 monthly payments of $50.00 each. First payment due 10/10/2015, for a total of $65 including registration fee. Seven payments (Nov-May on the 5th of the month) of $50 each by electronic fund transfer. Please complete Monthly Payment Authorization Form.

We want all students to participate in Elementary Strings regardless of financial considerations. Please contact the CYSA Orchestra Manager (elementarystrings at gmail dot com or 541 – 766 – 4903) for information.

To insure that all students can participate in this enrichment activity, we welcome tax-deductible donations from our Elementary Strings families. The Corvallis Youth Symphony Association is a tax-exempt 501(c)3 organization. Please see Donate page for more information.

Paypal Payment Option

Payment Options
Student Name

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