EmailMe Form - Jacksonville Children's Chorus- Vocal Exploration

Singer's Name *

First Last

Gender *

Female

Male

Age *

Grade *

Date of Birth *

MM / DD / YYYY

School Attending 2012-2013 *

Music Teacher *

Ethnicity *

Parents or Guardians *

Singer's Home Mailing Address: *

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

Billing Address (if different)

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

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, I heareby 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

TUITION AND FEES

Tuition: $159
Registration Fee: $25
Total: $184

Registration fee is due now.
Tuition is due no later than October 1st, 2012, but can be paid now.

After Submitting this registration form you must make your $25 Registration Payment in order to be fully registered.

Pay your registration fee by:

* calling our office with a credit card number (353-1636)
* mailing in a check or money order
* drop off cash at our office

Jacksonville Children's Chorus
225 E. Duval Street
Jacksonville , FL 32202

If you have any questions please call the office (904) 353-1636

Agreement *

I agree to pay the complete tuition, and registration fee.

Parent 1/Guardian 1 Contact information

Parent 2/Guardian contact information

TUITION AND FEES Tuition: $159 Registration Fee: $25 Total: $184

TUITION AND FEES

Tuition: $159
Registration Fee: $25
Total: $184