EmailMe Form - First Steps in Music (Spring 2018)

Child's Name *

First Last

Gender *

Female

Male

Age *

Date of Birth *

MM / DD / YYYY

Tuition:
First Steps in Music is a ten-week program

Cost: $120.00 for all ten classes

Due by January 17, 2018 .

Saturday classes will be held at Mandarin Presbyterian Church, WEST CAMPUS, 2501 Leretto Rd, Jacksonville, FL 32223, starting February 3, 2018 through April 14, 2018.

There will be no classes on March 17th, 2018 as this is Spring Break for Duval County Public Schools.

Please choose one class to register for. *

Saturdays, 18 months - 3 years, 10:30-11:15 (Mandarin Presbyterian Church)

Saturdays, 3 years - 5 years, 11:30-12:15 (Mandarin Presbyterian Church)

Ethnicity *

Parents or Guardians *

Child's Home Mailing Address: *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Parent 1/Guardian 1 Contact information

Name *

First Last

Home Phone *

### - ### - ####

Employer:

Work Phone

### - ### - ####

Cell Phone *

### - ### - ####

Email *

Parent 2/Guardian contact information

Name(2)

First Last

Home Phone (2)

### - ### - ####

Employer:(2)

Work Phone (2)

### - ### - ####

Cell Phone (2)

### - ### - ####

Email(2)

In consideration of my child's participation in the Jacksonville Children's Chorus First Steps in Music Program, I hereby authorize the videotaping, photography, and recording of the above referenced registrant, and/or release of his/her name and achievements for educational, promotional, and other purposes deemed appropriate by officers of the Jacksonville Children's Chorus. I also authorize the use of the videotape/photography and other information regarding my child in printed matter or other media for presentations by the Jacksonville Children's Chorus without my further consent. I hereby agree that such media information shall be the sole property of the Jacksonville Children's Chorus. *

I agree

How did you hear about our "First Steps In Music" program? *