EmailMe Form - JCC Vocal Exploration Spring 2022

Singer's Name *

First Last

Gender *

Female

Male

Age *

Grade *

Date of Birth *

MM / DD / YYYY

School Attending 2021-2022 *

Music Teacher

Ethnicity *

Singer'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

Parent 1/Guardian 1 Home Mailing Address: *

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

Land Line

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

Employer:

Work Phone

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

Cell Phone

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

Email *

Parent 2/Guardian contact information

Name(2)

First Last

Parent 2/Guardian 2 Home Mailing Address:

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

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 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

After submitting this registration form, you will be redirected to the payment page. YOU MUST MAKE YOUR $25 REGISTRATION PAYMENT IN ORDER TO BE FULLY REGISTERED.

You can also pay your registration fee by:

1. Paying via link in registration email
2. Calling our office with a credit card number (904-353-1636 ext. 2)
3. Mailing in a check or money order | drop off cash at our office

Jacksonville Children's Chorus
10131 Atlantic Blvd
32225

If you have any questions please call the Program office (904) 353-1636 ext. 1.

TUITION AND FEES

Tuition: $182.00
Registration Fee: $25.00 (Non-refundable).
Total: $207.00

Registration fee is due at the time of enrollment.
Tuition is due no later than March 3, 2022

Agreement *

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