EmailMe Form - First Steps in Music (Fall 2018)

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: $49.00 for all five classes.

Due by August 25, 2018 .

All classes will be held at First United Methodist Church, starting September 12, 2018 through October 11, 2018.

Please choose ONE class to register for. *

Wednesday, 18 months - 3 years, 9:30-10:15

Wednesday, 3 years - 5 years, 10:30-11:15

Thursday, 18 months - 3 years, 9:30-10:15

Thursday, 3 years - 5 years, 10:30-11:15

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

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