EmailMe Form - First Steps in Music, July 2017

Child's Name *

First Last

Gender *

Female

Male

Age *

Date of Birth *

MM / DD / YYYY

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

Cost: $90.00 for all five classes

Due by July 6, 2017.

Classes will be held at First United Methodist Church, 225 E. Duval Street, Jacksonville, FL 32202.

Please choose one class to register for. *

2 1/2 years - 4 years, 9:30am-10:30am

18 months - 2 1/2 years, 10:30am-11:30am

2 1/2 years- 4 years , 11:30am-12:30pm

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? *