EmailMe Form - Free Virtual Preschool Class

Type of Registration

Individual

Daycare Center

Preschool

Child's Name *

First Last

Choose your class time

Tuesdays | 10:00 - 10:30 am

Wednesdays | 11:00 - 11:30 am

Email *

Did you participate in the previous month's Virtual Preschool Class?

Yes

No

Has any information (age, address, email, etc.) changed since last month's registration?

Yes

No

Gender *

Female

Male

Age *

Date of Birth *

MM / DD / YYYY

Ethnicity *

How did you hear about our "Preschool Music Classes"? *

Please explain how you heard about us. *

Participant Information

Child's Home Mailing Address: *

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

Parent/Guardian Contact information

Name *

First Last

Cell Phone *

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

Email (This should be your most often checked email address) *

What is your combined household income? (Required for funding purposes.)

$78,400 or less

$78,401 or more

MEDIA RELEASE
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

I disagree