Registration Form Singer/Parent Information 2021-22 Season *ALL fields must be filled in prior to submitting the registration form. SINGER INFORMATION Singer's Name: FIRST LAST Birth Date: (MM/DD/YYYY) Singer's name as you wish it to appear in programs: (first and last name only) Address: City: State: Zip: Choir: PreparatoryApprenticeLyricWhitleyTrebleConcertYouth Chorale SELECT SINGER'S T-SHIRT SIZE: ---Youth MYouth LAdult SAdult MAdult LAdult XLAdult XXL Lives with: (if other, please state with whom below) mother and fathermotherfatherother Gender: malefemale Race: African AmericanAsianBi-racialCaucasianHispanicOther School: School Corporation: Grade in Fall: I was referred by current FWCC singer: 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 in which you prefer we communicate: HOW PARENTS CAN HELP: The commitment of both singers and parents is essential to the success of the FWCC. Parent involvement is needed and appreciated. Please check the areas below where you would like to volunteer. Choir Secretary: Attend every rehearsal and concert to keep records of attendance and prepare information to go home.Rehearsal Assistant: Attend rehearsals, assist director as needed, and ensure singers remain focused.Greeter: Welcome singers as they arrive for rehearsal and ensure their way to the rehearsal room.Choralfest Assistant:First AidRehearsal AssistantLunch AssistantConcert Assistant *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: Physician: Physician Phone: Preferred hospital: Insurance carrier: Prescription medications: (please explain) Allergies: Does your child carry an EPI Pen? yesno Please list any special health conditions: Important: Please read our COVID-19 Waiver here: Click here to view (Link opens in new window) MEDICAL RELEASE: In the unlikely event that my child becomes ill, and I or the authorized physician 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. *I have read and accept the terms in the COVID-19 Waiver: *I release the FWCC, their employees and agents from any claims of liability in connection therewith. PAYMENT OPTION: If you are paying by check, please make payable to the FWCC and enter "CHECK" into the card number field below. All other payment plan options require credit/debit card use. All fields must be completed prior to submitting the form. Name on the card: Card Type: Card Number: Exp. Date: I prefer my payment to be made on the: 1st of the month15th of the month Payment Option: 1 payment (June)3 payments (June, August, October)6 payments (June-November)10 payments (June-March) I approve these payments to be applied as requested above. TRAVEL AGREEMENT: I give the Fort Wayne Children’s Choir permission to transport my singer to and from any choir related function when applicable. I release the Fort Wayne Children's Choir, their employees and agents from any claims of liability in connection therewith. PHOTOGRAPHY RELEASE: I give my permission for my child’s image to be used in all marketing materials. YesNo RELATED MATERIALS: I give the Fort Wayne Children’s Choir permission to share my home and email addresses with related organizations with the intent of receiving arts-related information. YesNo *The final 2 sections require a digital signature from both the singer and the parent/guardian of each singer.* SINGER CONTRACT: As a singer in the Fort Wayne Children’s Choir, I agree to make my participation a high priority and to honor this commitment for the entire choir season. I understand this commitment includes all rehearsals, performances, and travel. I also agree to be on my best behavior and conduct myself appropriately during rehearsals, performances, and travel. I understand the director is in charge and has the authority to remove me from a rehearsal or performance if my behavior or level of participation is inappropriate and/or detrimental to the orderly progress of the choir. (Please sign in the space below. Desktop users may use your mouse, mobile users may use their finger or stylus.) Singer Signature: Date: 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: Date: 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.