New Westchester Symphony Orchestra - Parent/Guardian Notification and Consent Form

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To be completed by parents/guardians of minors under the age of 18 who wish to play with New Westchester Symphony Orchestra.

I am aware that my child is participating in New Westchester Symphony Orchestra (NewWSO) rehearsals and/or concerts, which take place at various times and locations in Westchester County, NY *

(fill in name of child)

I understand that my child may travel to rehearsal and concert venues by various forms of public and/or private transportation. I understand that there may be risks involved in my child’s departure from his/her home or school without adult supervision, and I assume those risks on behalf of my child and myself. *

(please initial)

To help increase awareness of NewWSO for other students and for the general public, I give permission for New Westchester Symphony Orchestra to use my child’s: *

(check all that apply)

Image or photograph

Name

Age

School affiliation

Written and/or recorded oral statements made in or about NewWSO solely for NewWSO's non-commercial purposes, including promotion of NewWSO and use in any manner or media, now and in the future, throughout the world.

I do NOT give permission for use of any of the above

Required

I understand and accept all of the conditions outlined above. *

(full name of parent/guardian - this serves as your electronic signature)

Today's Date *

YYYY

Telephone of parent/guardian *

Emergency Contact

(name and phone number)

Submit

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