EmailMe Form - Primary Choir Fall 2021

Please select which day you will be attending.

Singer's Name *

First Last

Grade *

K

1st

2nd

School Attending 2021-2022 *

Music Teacher *

Gender *

Female

Male

Age *

Date of Birth *

MM / DD / YYYY

Ethnicity *

Parent 1/Guardian 1 Contact information

Name *

First Last

Singer's Home Mailing Address: *

Street Address City State / Province / Region Postal / Zip Code

Billing Address (if different)

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

Email *

Cell Phone *

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

Home Phone

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

Employer:

Work Phone

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

Parent 2/Guardian contact information

Name(2)

First Last

Email(2)

Cell Phone (2)

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

Home Phone (2)

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

Employer:(2)

Work Phone (2)

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

How did you hear about us? *

JCC Parent Volunteer Auxiliary
The parent/volunteer auxiliary support group will work with singers, parents, and JCC staff to foster social interaction, enhance communication, and promote the mission of the JCC. Members are welcome and appreciated! *

Yes!

No, Thank you.

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

TUITION AND FEES

Agreement

Tuition: $252.00

Registration Fee: $25.00 (Non-refundable).

Total: $277.00

Registration fee is due now.
Tuition is due on or before October 15, 2021

AFTER SUBMITTING THIS REGISTRATION FORM, YOU MUST MAKE YOUR $25 REGISTRATION PAYMENT IN ORDER TO BE FULLY REGISTERED.

Options to pay your registration fee:
* Pay online. Upon submission of this form, you will be redirected to a page with with "Submit Payment" option.
* Call our office with credit card number (904-353-1636 ext. 2)
* Mail check or money order
* Make payment at our office
Address:
Jacksonville Children's Chorus
10131 Atlantic Blvd.
Jacksonville, FL 32225

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

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