EmailMe Form - Free Virtual Preschool Class

Type of Registration *

Individual

Daycare Center

Preschool

Choose your class time *

Tuesdays | 10:00 - 10:30 am

Have you previously attended Virtual Preschool? *

Yes

No

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

Please explain how you heard about us. *

Participant Information

Preschool/Daycare Information

Child's Name *

First Last

Gender *

Female

Male

Age *

(in years)

Race/Ethnicity *

(required for funding purposes)

Are you based in the United States? *

Yes

No

Are you based in Florida? *

Yes

No

Zip Code *

Home State *

(Two-letter abbreviation - e.g. "AL" or "CA")

Home Country *

Combined household income *

$78,400 or less

$78,401 or more

(required for funding purposes)

Preschool/Daycare Name *

Number of Students in Class *

(approximate if necessary)

Guardian Contact Information

Preschool/Daycare Contact Information

Name *

First Last

Cell Phone *

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

Email *

(This should be your most often checked email address)

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.

Do you agree to the terms of the Media Release above? *

I agree

I disagree