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

[group First_Steps_Yes]
If yes, how many sessions did you attend and at which location(s)?
[/group]

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

[group yes]
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

[group First_Steps_Yes2]
If yes, how many sessions did you attend and at which location(s)?
[/group]

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 student?:—Please choose an option—YesNo

[/group]

[group yes2]
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

[group First_Steps_Yes3]
If yes, how many sessions did you attend and at which location(s)?
[/group]

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 student?:—Please choose an option—YesNo
[/group]

[group yes3]
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

[group First_Steps_Yes4]
If yes, how many sessions did you attend and at which location(s)?
[/group]

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?

[/group]

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
[group financial_yes]
Your credit card will not be charged until after your financial assistance application has been reviewed. Please follow this link to the Financial Assistance Form: Financial Assistance Form
[/group]
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.

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