Child's Name

DOB

Parent / Guardian Name

Phone

Address

Email Address

School Child Attends

*Names of those with permission to collect child

Food Allergies / Health Issues

Emergency Contact 1

Phone

Emergency Contact 2

Phone

Are you able to be a parent volunteer? Y/N

Do you have a current DCSI clearance? Y/N

Fees Payable (refer below)

T-Shirt Size (Child or Adult S, M, L)

Liability and Photo Release Liability and Photo Release I acknowledge the Liability release: In consideration of accepting your child(ren) in our program, the undersigned individual, parent or guardian hereby agrees to indemnify and keep harmless, the Murray Bridge Children’s Choir and their employees against any all liability claims, judgments, or damage arising as a result of participation in our program, or as a result of any course of instruction or supervision given the participant those entities listed above. Furthermore, said entities are not responsible for the supervision of participant either before or after regularly scheduled class time. I allow the right to photograph my child and use the photo for publication purposes only.