Longmont Youth Symphony Information Form Musician Name * First Name Last Name Instrument * Musician Email * Musician Mobile (###) ### #### School * Grade * Private Teacher Name Parent/Guardian Info Parent/Guardian 1 Name * Parent/Guardian 1 Email * Parent/Guardian 1 Mobile * (###) ### #### Parent/Guardian 2 Name Parent/Guardian 2 Email Parent/Guardian 2 Mobile (###) ### #### Emergency Contact Name (if not listed above) Emergency Contact Phone (###) ### #### By clicking the checkbox below, I consent to the use of my child’s name, photographs, musical reproduction(s), and video images of him/her by the Longmont Youth Symphony Orchestra and/or Longmont Youth String Ensemble and/or the Longmont Youth Symphonic Band without compensation, for the following uses: publication on the organization’s website, use in flyers, pamphlets, posters, and other promotional or educational publications, and any other reasonable and necessary use associated with the Longmont Youth Symphony. All negatives, positives, prints, digital reproductions and videotape shall be the property of the Longmont Youth Symphony. I hereby release the Longmont Youth Symphony and their licensees, assignees, and contractors from any and all claims and demands arising of or in connection with the use of the aforementioned material. I Consent Thank You!
