Summer Chamber Music Application - EPSYO | El Paso Symphony Youth Orchestras

UTEP CHAMBER SUMMER CAMP 2025

STUDENT APPLICATION

Student's Full Name(Required)

First Last

Student Status(Required)

Student's Current Address(Required)

Street Address City ZIP / Postal Code

*Please be sure this address matches your billing address

Student's Contact Number(Required)

Student's Email Address(Required)

Student's Age(Required)

Please enter a number from 5 to 25.

*as of July 2025

Instrument(Required)

Student's School(Required)

*attended during Spring, 2025

Student's Grade(Required)

*as of Spring, 2025

Do you have a pre-formed ensemble that you would like to participate with at this camp?(Required)

If yes, please list your colleagues' names & instruments.(Required)

*If not applicable, please enter "N/A" to proceed with the application.

If yes, please list (if applicable) specific repertoire you'd like to study.(Required)

**If not applicable, please enter "N/A" to proceed with the application.

Video Audition Link(Required)

*Video submissions can be accepted through a YouTube or WeTransfer link. Actual video files cannot be accepted through this application. Please contact Mr. Nathan Black, nblack@epsyos.org, should you have any issues with the application or video upload. You may opt to send your video directly to Mr. Black, should that work best.

PARENT/ GUARDIAN INFORMATION

Mother's Name or Legal Guardian’s Name(Required)

First Last

Mother's or Legal Guardian’s Name Primary Email(Required)

Mother's Primary Phone Number (Area code + Number) (Example: 915-111-1234)(Required)

Father's Name or Legal Guardian's Name(Required)

First Last

Father's or Legal Guardian’s Name Primary Email(Required)

Father's Primary Phone Number (Area code + Number) (Example: 915-111-1234)(Required)

STUDENT'S EMERGENCY INFORMATION (EPSYO CHAMBER SUMMER CAMP 2025)

Student's Name(Required)

Full Name Full Last

Mother's or Legal Guardian’s Name Information(Required)

Full Name Emergency Number (Area code + Number) (Example: 915-111-1234)

Father's or Legal Guardian’s Name Information(Required)

Full Name Emergency Number (Area code + Number) (Example: 915-111-1234)

Doctor's Information(Required)

Full Name Emergency Number (Area code + Number) (Example: 915-111-1234)

#1 Relative/Friend Information(Required)

Full Name Emergency Number (Area code + Number) (Example: 915-111-1234)

#2 Relative/Friend Information(Required)

Full Name Emergency Number (Area code + Number) (Example: 915-111-1234)

STUDENT'S INSURANCE & HEALTH INFORMATION (EPSYO CHAMBER SUMMER CAMP 2025)

Name of Health Insurance/Group No. (If you do not have insurance, please check the box labeled “N/A”)(Required)

Please List Student's Medical Condition(s)(Required)

Explain Other Medical Condition(s) We should be aware of. If None, Please Write "N/A".(Required)

Student's Daily Medication(s) If Any. Type N/A if not applicable(Required)

Student's Prescribing Physician Information

First Last

MEDICAL AGREEMENT (EPSYO CHAMBER SUMMER CAMP 2025)

*I do hereby authorize the staff of the El Paso Symphony Youth Orchestras (EPSYO) to permit its designated representatives to give consent to a physician and/or hospital for immediate and/or emergency medical and/or surgical treatment when necessary to our son/daughter for sustained injuries or sickness requiring emergency treatment during EPSYO events provided such events have an authorized representative of the EPSYO present. It is understood that the EPSYO or its representatives do not assume any financial responsibilities for any expenses that might be incurred for said emergency treatment, and the EPSYO will notify us as soon as possible following the emergency, but in no way is treatment to be delayed until we have been notified. I understand that EPSYO authorities and staff may inform other school personnel of my child’s medical condition(s) and/or disability when necessary for my child’s well-being.

By typing my name below, I am electronically signing this medical form. I am also responsible for providing the EPSYO via email with any medical updates or changes for my child in this medical form throughout the Summer Camp 2025 session, for better emergency practice purposes.(Required)

Mother/Legal Guardian E-Signature Signing Date

By typing my name below, I am electronically signing this medical form. I am also responsible for providing the EPSYO via email with any medical updates or changes for my child in this medical form throughout the Summer Camp 2025 session, for better emergency practice purposes.(Required)

Father/Legal Guardian E-Signature Signing Date

EPSYO CHAMBER SUMMER CAMP 2025 AGREEMENT & CONSENT(Required)

Upon submission of this application, I acknowledge the information listed and consent to the following:

*The EPSYO summer camp fee of $150.00 is the responsibility of the participant. Due to a high volume of students, EPSYO will not individually contact families to collect payments. It is the participant’s responsibility to ensure that their fee is paid by July 7th, 2025. To make your summer camp payment, please visit our website and complete the payment process. Paying camp fees in advance helps keep the camp running smoothly.

BEFORE YOU SUBMIT YOUR EPSYO CHAMBER SUMMER CAMP APPLICATION 2025(Required)

I understand & agree to re-submit my entire EPSYO application if submitted incomplete or containing errors.

*You must thoroughly review your application for accuracy, including verifying all information in the informational boxes. Incomplete applications or those containing errors will require resubmission of the entire application, as the EPSYO cannot make changes to submitted applications.

Please don’t hesitate to contact us, we’re happy to help! (915) 525-8978 or 915-227-2299.