Name                                                                                          Phone                                                      

Address                                                                                      Email                                                       

City & Zip                                                                                    School                                                     

Instruments                                                             How Long                            Age              Grade           

Taking Lessons?                Private?                Music Teacher’s Name                                                            

1. Current Ensemble and Orchestra Involvement (How long?)

2. Past Ensemble and Orchestra Experience  (How Long?)

I understand that the purpose of the orchestra is for adults to work with the youth participants, ages 12 to 18, in a
mentoring and coaching arrangement during  the rehearsals. I also understand that the scope of the program arranged
and supervised by Pontiac Bay Symphony Orchestra consists of the scheduled rehearsals, sectionals, and concerts.
Rehearsals are also open to the parents of youth participants. Pontiac Bay Symphony Orchestra has not arranged or
approved any other activities for the orchestra participants beyond the rehearsals and concerts. However, Pontiac Bay
Symphony Orchestra does facilitate phone and email communication among all participants during the course of the
program as a way to communicate orchestra news, information, and activities, and prepare for rehearsals and concerts.

 Parent’s Signature                                                                           Date

 Printed Name                                                                                  Contact Phone / Email Address

  Please mail application to:  PBSO, P.O. Box 27307, Seattle, WA 98165-1807