OSYO 2025-26 Member Registration Form

"*" indicates required fields

Step 1 of 5

This process (including all preparations and completing the form) will take about 20–30 minutes. To navigate to previous pages, please use the form’s “Previous” button. Using your browser’s back button will reset the form to the first page. Before you begin, please have the following documents and information ready:

* Current passport
* Any clear, full-face photo
* Current Medical Insurance Card
* Double-check that all dates and times entered on the form are correct.

Form Sections

1. Parent Information & Other Emergency Contact
2. Student Profile Information
3. Document Uploads: Photo and Medical Insurance card
4. General Health Info including Agreement & Consent for Medical Care (adult signature required)
5. Retreat Information & Agreement (student & adult signature required)
6. Participation, Liability, and Waiver Agreement (adult signature required)
7. Payment Options

PARENT/GUARDIAN CONTACT INFORMATION

Both parent/guardian information must be provided, if applicable.

Parent/Guardian #1

Parent/Guardian #1 = Billing/Permissions/Emergency Contact Info

Parent/Guardian #1 Name*

First Last

Parent/Guardian #1 Relationship to Student*

Parent/Guardian #1 Email*

Enter Email Confirm Email

Parent/Guardian #1 Phone*

Best number to reach you

Phone Type

Parent/Guardian #1 Occupation*

Parent/Guardian #1 Employer*

Parent/Guardian #2

Parent/Guardian #2 Name

First Last

Parent/Guardian #2 Relationship to Student*

Parent/Guardian #2 Email

Enter Email Confirm Email

Parent/Guardian #2 Phone

Best number to reach you

Phone Type

Parent/Guardian #2 Occupation

Parent/Guardian #2 Employer

ALTERNATE EMERGENCY CONTACT INFORMATION

Please name someone other than your parent(s) or guardian(s).

Alternate Emergency Contact Name*

First & Last

Alternate contact relationship*

Alternate Emergency contact email*

Enter Email Confirm Email

Alternate Emergency contact phone*

Alternate Emergency contact phone type*

STUDENT REGISTRATION FORM

Student Photo Upload*

Upload a recent photo that shows your entire face, without any accessories such as hats or sunglasses. Prescription eyeglasses are OK.

Drop files here or

Max. file size: 128 MB.

Health Insurance Card*

Scan the front and back of your Medical Insurance Card

Drop files here or

Max. file size: 128 MB, Max. files: 2.

Student Information

Student Name (as shown on passport or legal document)*

First & Middle Last Preferred Name

Gender*

Date of Birth*

Student Email (if none, leave blank)

Enter Email Confirm Email

Student Mobile Phone (if none, leave blank)

Student resides with:*

Additional languages spoken in the home:

Any relatives in the Oakland Symphony organization?

This includes OSYO, Pro Orchestra, Chorus, MUSE, and Bridge. Include full name, relationship, and instrument.

Ethnicity*

Student Home Address

Address*

Street Address City State ZIP Code

Student Musical Information

Instrument*

Years on Instrument*

Enter the number of years in OSYO, including this upcoming season.*

Season or Year started at OSYO

Example: 2023-24 or Spring 2024

Private Instructor Full Name. If none, write "none".**

First & Last Name

Private Instructor's Email

Private Instructor's Phone Number

Private Instructor's Location (City)

Years of Private Study on Current Instrument*

Currently taking private lessons?*

School Music Information

School*

Other School*

Student's Grade this Fall*

School music program participant*

School music program(s) student is in.*

To select more than one item, please hold down the CTRL key on a PC or Command key on a Mac.)

Planning to participate in school music program?*

Please explain "NO" response*

School Music Teacher's Name*

First & Last Name

School Music Teacher's Email, if known

STUDENT HEALTH INFORMATION

Note: Medical information is collected for emergency use only and will remain confidential. Please note that OSYO staff does not administer any medication to students.

These questions help us ensure the safety and well-being of all participants during youth orchestra events, including retreat and tour. While we are not traveling with medical professionals, nor administering medications, having a general understanding of any medical conditions or activity restrictions allows us to make informed decisions in case of an emergency and provide appropriate accommodations if needed.

Is the student vegetarian?*

Does student have a nut allergy?*

Is student on a gluten-free diet?*

Height (ft & in)*

Weight (lbs)*

Immunizations

Date of most recent Tetanus vaccination*

Date of most recent MMR vaccination*

COVID-19 Vaccination Status

General Health

1. Is the student under a physician’s care for a physical or mental condition?*

2. Are there any activities the student should be restricted from participating in?*

Please explain selections by first noting the number of the question.*

Mental, Emotional, and Social Help

Has the student ever been treated for:

1. ADD or ADHD?*

2. Emotional/behavioral difficulties or an eating disorder?*

3. During the past 12 months, seen a professional to address mental or emotional health concerns?*

4. A significant life event that continues to affect the participant's life? For example, a history of abuse, death of a loved one, family change, new sibling, survived a disaster, adoption or others.*

Mental, Emotional & Emotional Help: Please explain selections by first noting the number of the question.*

Health History

Select those the student has / had: To select more than one item, please hold down the CTRL key on a PC or Command key on a Mac.*

Health History: Please explain selections by first noting the number of the condition. Please briefly describe any orthopedic devices (i.e., crutches or braces) that will be brought to camp/on tour. For travel outside the country, please name the countries visited and the dates of travel.*

FOOD: Allergies, Diet, and Nutrition

Food and diet restrictions: (To select more than one item, please hold down the CTRL key on a PC or Command key on a Mac.)

If the student is following a gluten-free diet, is it a medical necessity?*

Please share any details about food limitations or allergies and briefly describe the reactions.

ALLERGIES: Medications or the Environment

Please let us know if the participant is allergic to any medications or the environment. (To select more than one item, please hold down the CTRL key on a PC or Command key on a Mac.)*

Please share any details about environmental or medication allergies and briefly describe the reactions.*

If the student has any other allergies that are not listed, please list them here. Include the reactions and any other relevant information.

MEDICATIONS: Medication Guidelines

Please note that our summer camp retreat will only have a basic first aid kit available. With parent consent, students are responsible for bringing and self-administering all necessary medications. --- Medications "Medication" is any substance a person takes regularly or as needed to alleviate symptoms. This includes vitamins & natural remedies, over-the-counter medications, and prescriptions. --- The following packaging instructions must be followed or we will be forced to consider the medications as unsafe and contact you for replacements. All medications, whether prescription or over-the-counter, must be in their original packaging. Prescriptions should have the pharmacy label showing the student’s name, dosage, and how the medication should be given. Check the expiration date; no expired medications can be administered. Provide enough of each medication to last the duration of camp/tour. Do not send medication in pill boxes, baggies, or mixed in bottles with other medications.

Does the student take any medications as defined above?*

Please list every medication the participant will take while on camp and tour, including the name and purpose. If it is a medication taken regularly, please include the frequency and dosage.*

MEDICATIONS ACCEPTABLE TO TAKE*

Please select the medications below giving permission for the medical professional to administer these medications, according to package instructions, in case of an emergency. If you do not select “My student may be administered all of the below medications”, please note that any medications not selected CANNOT be administered by the medical professional. To select more than one item, please hold down the CTRL key on a PC or Command key on a Mac.

AGREEMENT AND CONSENT FOR MEDICAL CARE - PARENT/GUARDIAN SIGNATURE ONLY (OVER 21)

The information I have supplied on this health summary is complete and accurate to the best of my knowledge. In case of emergency, I understand that every effort will be made to provide medical care. In the event an emergency contact cannot be reached, I hereby give my permission and consent to the medical professional selected by OSYO to secure proper treatment for my child, including hospitalization, anesthesia, surgery, and injections of medication. I hereby assume to pay any indebtedness or physician’s/surgeon’s fees and hospital fees for such services warranted. By checking the Agreement and Consent for Medical Care box, I agree and it is my intent to electronically sign and electronically submit this Authorization. I understand that by checking the “I agree” checkbox, I will be applying my electronic signature to this Authorization and that I will be bound with the same force and effect as if I had signed this Authorization on paper by hand.

Parent/Guardian #1 Signature- Agreement & Consent for Medical Care*

Signature Date*

Parent/Guardian #2 Signature- Agreement & Consent for Medical Care

Signature Date

YOUTH ORCHESTRA RETREAT INFORMATION - STUDENT & PARENT/GUARDIAN SIGNATURES

Please download the Youth Orchestra Retreat Information and review retreat rules.

Retreat Participant Signature*

STUDENT: By typing my name in the box below, I am providing my e-signature accepting that I have read the Retreat rules and agree to abide by them. I understand that if I violate one or more of the rules, I may be sent home.

Retreat Signature Date (Participant)*

Retreat Parent/Guardian Signature*

PARENT/GUARDIAN: By typing my name in the box below I am providing my e-signature accepting that I have read the Retreat rules and acknowledge that it is my responsibility to pick up my child if they have violated the rules and are asked to leave. It is also my responsibility to notify the OSYO Office in advance if my child will be late arriving at retreat or will be absent at any time during the weekend retreat.

Retreat Signature Date (Parent/Guardian)*

PARTICIPATION ACCEPTANCE, WAIVER, AND MEDIA RELEASE - PARENT/GUARDIAN SIGNATURE ONLY (OVER 21)

I have read the OSYO Participation and Liability Waiver Agreement and understand that by checking this box and providing my name below, I am giving up legal rights and/or remedies that may be available to Student, to me and to any other parent or guardian of Student, and to their respective heirs, next of kin, and legal representatives.

Acceptance/Waiver/Release - Signature*

Acceptance/Waiver/Release Date*

FINANCIAL AID

Financial Aid is need-based. If you’re concerned about OSYO tuition, we encourage you to apply for financial assistance. Financial Aid applications will be handled through the Private School Aid Service (https://online.factsmgt.com/signin/4L3Q4). This is an additional step that you must complete if you are applying for financial aid. The deadline to submit your Financial Aid application is August 15, 2025.

Please note: You are still required to submit the $625 non-refundable deposit and return your registration forms by the due date. If you are granted full financial aid, this deposit will be reimbursed. If you receive a partial grant, the deposit will be applied toward your remaining tuition balance.

WITHDRAWING MEMBERSHIP - NO REFUNDS

We would like to reiterate that by accepting a position in OSYO, you have made a season-long commitment. Participation fees are non-refundable.

PAYMENT OPTIONS

Full Tuition - $2,500

4 Installments - $625 each

Debit/Credit Card Payments: A processing fee of $5 applies per transaction.

Check Payments: Please make checks payable to:

Oakland Symphony Youth Orchestra
Reference the Student's full name and include "tuition"
Mail to: 1440 Broadway, Suite 405, Oakland, CA 94612.

All payments are non-refundable upon receipt.

Tuition Payment Deadlines

8/1/25 - Full Tuition or 1st Installment
9/12/25 - 2nd Installment
10/26/25 - 3rd Installment
12/7/25 - 4th Installment

Choose your payment option.*

You may change your selection on the payment page.

Full Tuition ($2,500)

Installment Plan ($625)

Applying for Financial Aid ($625 Deposit)

None of the below
1. ADD/ADHD
2. Arthritis
3. Asthma/Wheezing/Shortness of Breath
4. Back or joint problems
5. Chronic Illness
6. Chronic mental illness
7. Convulsions/Epilepsy
8. Dental braces/Retainers
9. Depression
10. Diabetes
11. Ear Infections
12. Ever been hospitalized
13. Eye problems
14. Fainting or Dizziness
15. Glasses/Contact Lenses/Protective Eyewear
16. Headaches
17. Hearing Aid
18. Heart problems
19. Heat exhaustion
20. Heat stroke
21. High blood pressure
22. Lung disease
23. Lung infections
24. Lyme disease
25. Menstrual problems
26. Mononucleosis (mono) during the past 12 months
27. Motion sickness
28. Nose bleeds
29. Orthopedic braces
30. Passed out/head chest pain during exercise
31. Physical disability
32. Poison oak
33. Problems with falling asleep or Sleepwalking
34. Recent injury
35. Recent serious illness
36. Recent surgery
37. Rheumatic fever
38. Seizures
39. Sickle cell anemia
40. Skin problems
41. Sore throat
42. Stomach problems (diarrhea or constipation)
43. Traveled outside the country in the past 9 months
44. Weak ankles or knees