EmailMe Form - Sing and Play Discovery Day

Child's Name *

First Last

Choose ONE class from the following list for your child that is 18 months - 3 years old:

Saturday, November 17th, 10:00-10:45am

Saturday, December 1st, 10:00-10:45am

Choose ONE class from the following list for your child that is 3 - 5 years old:

November 17th, 11:00-11:45am

December 1st, 11:00-11:45am

Gender *

Female

Male

Age *

Date of Birth *

MM / DD / YYYY

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 Preschool 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

How did you hear about our Preschool Music Classes? *