Last Name
*
First Name
*
Email Address
*
Age as of July 1, 2021
*
Date of Birth
*
MM
DD
YYYY
Home phone
*
Country
(###)
###
####
Allergies
(please describe/explain any allergies you may have)
Medications you are taking (including dosage)
Date of most recent tetanus/diphtheria (DTaP) inoculation
Insurance Company Name
*
Insurance Company Address
*
Policyholder's Name
*
Contact #1 Name
*
Contact #1 Relationship to Participant
*
Contact #1 Phone
*
Country
(###)
###
####
Contact #1 Email
*
Contact #2 Name
*
Contact #2 Relationship to Participant
*
Contact #2 Phone
*
Country
(###)
###
####
Contact #2 Email
*
Additional information
If other information would be helpful in reaching contact persons, please mention it here:
I, being 18 years of age or older, (or on behalf of my child or ward, if under the age of 18 years), know of the risks involved in national/international travel and participation in national/international events, including any risks related to transportation. I understand the risks inherent in travel and in such participation, and I choose to accept any and all responsibility for my safety and welfare (or the safety and welfare of my child/ward) while participating in the Fresno Summer Orchestra Academy (FOOSA Festival). With full understanding of the risks involved, I release and hold harmless, jointly and individually, Youth Orchestras of Fresno, the Executive Director, the Music Director, the Board of Directors, and members of the organizing committee from and against any claims, liability, damage, injury, loss, penalty, or expense I or my child incur or suffer as a result of participation in the FOOSA Festival. I agree to take no legal action against Youth Orchestras of Fresno and/or the above-mentioned individuals because of any accident, mishap, injury, illness, or death relating to participation in the Festival.
*
required form; checking the box indicates legal agreement
Participant's name
*
Parent/guardian release agreement
REQUIRED for participants under 18
Parent/guardian name
I, the undersigned (or undersigned parent/legal guardian, if participant is under 18 years of age), fully understand that photos and videos may be made during the course of the Festival, and that images may be used for internal, archival, educational, and/or promotional purposes. I give permission for use of my/participant’s image and/or voice or other performance by the FOOSA Festival without any compensation to me or my child/ward.
*
required form; checking the box indicates legal agreement
Participant's name
*
Parent/guardian agreement
REQUIRED for participants under 18
Parent/guardian name
I, the undersigned (or undersigned parent/legal guardian, if participant is under 18 years of age), recognize that musical instruments may be fragile and valuable, and hereby agree to accept and assume all risks of injury to any instruments I bring to the festival. I hereby release and hold harmless, jointly and individually, Youth Orchestras of Fresno, the Executive Director, the Music Director, the Board of Directors, and members of the organizing committee from any liability for any injury or damage to my instrument(s), whether from anyone's negligence or not, or any other cause, arising from my participation in the FOOSA Festival and its related activities.
*
Participant's name
*
Parent/guardian release agreement
REQUIRED for participants under 18
Parent/guardian name
Date signed
*
MM
DD
YYYY
I, the undersigned, do hereby authorize the FOOSA Festival and its designated representatives to consent, on my behalf, to any medical/hospital care or treatment to be rendered upon the advice of any licensed physician. I agree to be responsible for all necessary charges incurred by any hospitalization of treatment rendered pursuant to this authorization. The effective dates for this authorization are July 6 through 16, 2021.
Required for participants 18+
I, the undersigned parent or legal guardian, understand that there are some risks inherent in the activities that are included in Festival programs, but I willingly assume these risks in order to allow my child to participate. If I cannot be reached in the event of an emergency, I give permission for any care or treatment by a physician, surgeon, hospital, nurse, doctor’s assistant, or medical care facility that may be required.
REQUIRED FOR ALL UNDER-18 PARTICIPANTS!
Parent/guardian name
Date signed
MM
DD
YYYY
Thank you!
Thank you for completing your online FOOSA forms.
For participants who will need housing during the festival, we have another intake form. You will be housed in dorms on the Fresno State campus. Please click to access our FOOSA DORM INFORMATION FORM
