Form Test

SINGER INFORMATION

Singer's Name:
FIRST LAST
Birth Date: (MM/DD/YYYY)

Please select which day of the week you would like to attend:
MondayTuesday

Please select which Prep sessions you would like to register for (check all that apply):
Session 1Session 2Session 3

Did your singer participate in our First Steps in Music program? —Please choose an option—YesNo

SELECT SINGER'S T-SHIRT SIZE:
—Please choose an option—Youth SYouth MYouth LAdult SAdult MAdult LAdult XLAdult XXL

Lives with: (if other, please state with whom below)
mother and fathermotherfatherother

Gender: malefemale

Race: African American/BlackAsianBi-racialCaucasianHispanic/LatinxOther
School:
School Corporation:
Grade in Fall:

MEDICAL INFORMATION

Prescription medications: (please explain)

Allergies:
Does your child carry an EPI Pen? yesno
Please list any special health conditions:

Important: Does your child have an Individual Education Program (IEP)? In order to serve your child, would you be willing to share that information with FWCC? YesNo

Does your child have any behavioral, social, or emotional challenges, that would be helpful for us to know?

Add another Prep singer?:—Please choose an option—YesNo

PARENT/GUARDIAN INFORMATION

FATHER'S/GUARDIAN'S INFORMATION

Name:
FIRST LAST
Address:
City:
State:
Zip:
Cell Phone:
Contact E-Mail:
Employer:
Occupation:
Work Phone:
May we call you at work? yesno

MOTHER'S/GUARDIAN'S INFORMATION

Name:
FIRST LAST
Address:
City:
State:
Zip:
Cell Phone:
Contact E-Mail:
Employer:
Occupation:
Work Phone:
May we call you at work? yesno

IMPORTANT:
Please enter the primary email address(es) in which you prefer we communicate:

*The following sections are to be reviewed by the parent(s)/guardian(s) of each singer. Please check the acceptance box for each section. If one is missed, there may an error when submitting.*
MEDICAL AND EMERGENCY INFORMATION
Emergency contacts (other than parent) if parent/guardian cannot be reached (please list two):
Emergency Contact Name #1: (first and last name)
Phone:
Relationship:
Emergency Contact Name #2: (first and last name)
Phone:
Relationship:
MEDICAL RELEASE: In the unlikely event that my child becomes ill, and I cannot be immediately contacted at the time of the emergency, and if in the judgment of the staff of the Fort Wayne Children’s Choir, immediate observation or treatment is necessary, I authorize and direct the staff to accompany my child to the hospital or physician most easily accessible.
PAYMENT OPTIONS:
I would like to apply for financial assistance: YesNo

Payment Information:

Enter Secure Payment Info *REQUIRED*

PHOTOGRAPHY RELEASE:
By my submission of the enrollment form, the Fort Wayne Children's Choir has my permission to photograph and record my child and to use the photographs and video footage publicly to promote the Fort Wayne Children’s Choir. I understand that the images and recordings may be used in print publications, presentations, websites, social media, and news outlets. The Fort Wayne Children’s Choir reserves the right to share content with media outlets and third party collaborators. I also understand that no royalty, fee, or other compensation shall be payable to me by reason of such use.

PARENT CONTRACT:
I agree to support the participation of my child in the Fort Wayne Children’s Choir for the entire choir season. I accept the terms of the above medical release, payment options, travel policy, photography policy and related material policy agreements. I understand that even if my child withdraws before the end of the season, I am still responsible for the total amount of tuition due and will be billed for all payments. Outstanding balances are subject to include attorney fees, court costs and other related expenses. I have reviewed the Singer Contract with my child and accept responsibility for my child.
(Please sign in the space below. Desktop users may use your mouse; mobile users may use their finger or stylus.)
Parent/Guardian Signature:

Important! Please be sure to review this form and verify that all of the required fields are complete prior to submitting. If you are unable to submit the form or receive an error message, make sure you have checked all "accept terms" boxes and try submitting again.

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