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Westmoreland Youth Symphony Orchestra Application
If you have any questions or concerns, please contact Ramona Coppage at
wysorc@verizon.net
.
Ensemble(s) of Interest
*
Philharmonic
Philharmonia
String Ensemble
Student Information
Student Name
*
First Name
Last Name
Phone
*
Email
*
Verify Email
*
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
School
*
Grade
*
Age
*
Extracurricular Activities
*
Instrument(s)
*
Violin
Viola
Cello
Bass
Flute
Oboe
Clarinet
Bassoon
Horn
Trumpet
Trombone
Tuba
Percussion/Timpani
Years of Study
*
Private Teacher (if applicable)
Name
First Name
Last Name
Years of Study w/ Private Teacher
Email
Verify Email
Parent/Guardian Information
Parent Name
*
First Name
Last Name
Email
*
Verify Email
*
Phone
*
Emergency Contact
*
Yes
No
Parent/Guardian #2
Parent Name #2
First Name
Last Name
Parent #2 Email
Verify Email
Parent #2 Phone
Emergency Contact Parent #2
Yes
No
Additional Emergency Contact
Name
First Name
Last Name
Phone
Relationship
Marketing, Media, Image, Recording Release
*
To Whom It May Concern: I give my child permission and consent to participate in publicity and media activities on behalf of the Westmoreland Symphony Orchestra Academy of Music organization or activities related to WSO organization events, rehearsals, concerts, or publicity, including photographs, reproductions, audio/video recordings, recordings for television, radio or social media, webcasts, interviews, etc., and to exempt the WSO organization from obligation and/or remuneration for the use of such material for publicity, marketing or other purposes. Image/Video Use Permission I further hereby grant permission for photographs/image files and/or video files of my son/daughter to be posted on the WSO organization website, YouTube channel, and other electronic communication tools/social media, and to be posted on the websites of foundations or agencies or included in annual reports, publications or publicity related to WSO organization activities, reports, programs, materials or events.
I agree
I disagree
News in your Inbox! Would you like to receive occasional emails about upcoming WSO concerts and special events?
Yes I would
No thank you
