Required information is indicated by an
*
Singer Information
*
Singers Name:
Date of Birth:
*
Grade - Fall 2011:
Address:
*
City:
*
State:
*
Zip:
Phone:
*
Parent's Email Address:
Please check here if you don't want your address, e-mail address or phone number given out to other choir members
Emergency Information
*
Parent(s)/Guardian(s) Name:
Occupation:
*
Phone:
Alternate Phone:
Parents/Guardians Name:
Occupation:
Phone:
Alternate Phone:
*
Alternate Contact to be notified in the event of an emergency:
Name:
Address:
Relationship to Singer:
*
Phone:
Physician / Clinic:
Address:
Phone:
Medical Insurer:
Policy Number:
List food, medicine, or environmental allergies, any other medical problems, or special needs you want to share about your singer:
Photo Release
I, the Parent/ Legal Guardian of the singer listed on this application, release the Lake Superior Youth Chorus (LSYC), affiliated organizations, and sponsors to use my singer's name, photographs, video images, and vocal recordings in LSYC related material and web sites.
*
Option:
Yes
No
*
Name of Parent/Guardian:
*
Date:
Copyright © 2011 Lake Superior Youth Chorus.
All rights reserved.
|
Home
|
About Us
|
Contact Us
|
Calendar
|
News
|
Members
|
Registration
|
Galleries
|
Follow us on
Web Management & Development by:
Lake Superior Web Design
