The Quad City Symphony Orchestra Association is committed to the health and safety of each QCSYE member and asks that a QCSYE Health Form be completed for each member enrolled in the 20-21 Season. The information below will remain confidential and will only be used in the case of an emergency.

For any questions, please contact Chelsea Sammons, QCSYE General Manager, at

  • If you have more than one member in the QCSYE, please complete one form per member.
  • It is possible that a situation might arise which requires that your child receive immediate medical care at the nearest medical facility. Please sign below if your child may undergo routine and emergency medical treatment. Every effort will be made to contact you and/or your child's emergency contacts in an emergency situation.


Funding for the QCSO website provided by the Scott County Regional Authority