PSE Application – Portland Summer Ensembles

Student Information

Student Name*

First Last

Instrument*

Student Age*

Number of Years Playing Instrument*

School (2024-2025)*

Grade (2024-2025 School Year)*

T-Shirt Size (Adult Only)*

Parent Information

Parent's Name*

First Last

Parent's Phone*

Parent's Email*

Student's Email*

Address*

Street Address Address Line 2 City State ZIP Code

Teacher Information

Name of Private Teacher*

First Last

Teacher's Email*

Teacher's Phone

Please have your teacher complete the online Teacher Recommendation Form by February 23rd.

Teacher Recomendation Form Delivery*

Automatically email the Teacher Recommendation Form to my private teacher at the email address I provided above when I submit this form.
I will deliver the teacher recommendation form to my private teacher myself.

All Applicants Answer the Following Question:

How did you hear about us?*

Hidden

Why would you like to enroll in this workshop?

Please Answer the Following Questions or Submit a Student Resume and/or Biography

What is your experience with playing chamber music?

Please list chamber music works that you have studied and/or performed:

Resume/Biography Upload

Drop files here or

Accepted file types: doc, docx, rtf, pdf, , Max. file size: 64 MB.

File types allowed: .doc, .docx, .rtf, and .pdf

PSE Repertoire

Would you like to play a chamber piece from a 20th or 21st century composer?

Yes
No

Let us know if there is something specific you would like to play.

Audition Alternative

I will NOT be able to submit a video audition. Please contact me regarding an alternative.

Photo/video Image Release*

Yes, I accept the below terms and conditions for photo/video image release (call MYS office with questions)
I do NOT accept the below terms and conditions for photo/video image release.

I give Portland Summer Ensembles (PSE) permission to photograph, and record video and audio images of the musician while participating in any PSE activity. I understand these images and recordings may be used by PSE to promote PSE and/or its musicians. I agree that neither I nor the musician will receive compensation for PSE’s use of such images or recordings.

WAIVER, RELEASE AND AGREEMENT*

Yes, I accept the below terms and conditions (call MYS office with questions)
No, I do not accept the below terms.

I hereby waive, release, discharge and agree to hold PSE/MYS and its officers, employees, directors and volunteers harmless from and against any and all claims, damages, injuries, or liability of any nature arising from or related to participation of the musician in any PSE/MYS activity, including but not limited to rehearsals, performances, and other activities, including without limitation those arising out of or attributable to exposure, infection, and/or spread of COVID-19 or any variant thereof. 2. Consent to medical care. As parent or guardian of the musician, in the event of a medical emergency in my absence, I authorize PSE/MYS to obtain medical care for the musician, including consent to administration of drugs or anesthesia, medical procedures, evaluation and treatment. I agree to indemnify PSE/MYS for any medical expense incurred by PSE/MYS in connection with the musician, whether or not it is reimbursed by my insurance.

Name

This field is for validation purposes and should be left unchanged.