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Musician Information
   
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*First Name:  
*Last Name:  
*Address:  
Address 2:
*City:  
*State:  
*Zip Code  
*Phone Number: x  
Cell Number: x  
Work Phone: x  
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Teacher Information
*First Name:  
*Last Name:  
*Address:  
*Telephone:  
Medical Information
*Medication/Allergies:  
*Emergency Information:  
*Doctor's Name & Number:  
Additional Information

Student Information

Age:
Type:
Grade In School as of 9/2017:
Cell Phone:
New Student:
Returning Student Years in GYO(as of 2017):

Parent’s (or Guardian’s) Information

*Parent First Name:  
*Last Name:  
Address:
Phone Number:
Cell Phone Number:
Business Phone Number:
*Secondary Email:  

Instrument:

*Primary Instrument:  
*Total Years of Study:  
*NYSSMA Level COMPLETED as 9/2017:  

Other/Alternative Instrument(s) (if any)

*Alternative Instrument:  
*Alt Years of Study:  
*NYSSMA Level COMPLETED as 9/2017:  
*Previous Orchestral:  
*How did you hear about Gemini Youth Orchestras?:  
During the 2017 season, are you participating in other non-school-related performing groups?
*Name of Orchestra:  

School Information

*School Student Attends:  
*School District:  
*School Orchestra/Band Teacher (Name):