EmailMe Form - Summer Songwriting Workshop

Singer/Participant's Name *

First Last

Gender *

Female

Male

Age *

Ethnicity *

Singer's Home Mailing Address: *

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

Parent/Guardian Contact information

Name *

First Last

Cell Phone *

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

Singer's Email
(to use for Zoom® link) *

Parent/Guardian Email *

How did you hear about our Songwriting Workshop? *

MEDIA RELEASE
In consideration of my child’s participation in these Jacksonville Children’s Chorus classes, I hereby authorize the videotaping, photography, and recording of my child, named in this registration form, 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

I disagree

Once you complete and submit this form, you will be redirected to payment screen to pay registration.