2023-2024 Children's Chorale Registration

Singer Name

Telephone

Address

Home Address, City, State, Zip Code

{name}

Age

Birthdate

Email Address

Parent/Guardian Name(s)

Parent/Guardian Address (if different from above)

Home Address, City, State, Zip Code

{name}

Parent/Guardian Cell Phone

Any medical issues, illness or health-related conditions we should be aware of?

If yes, please explain.

{name}

Any recent major health concerns?

If yes, please explain.

{name}

Any allergies?

If yes, please explain.

{name}

List all medications that are being taken (include dosage):

{name}

Family Doctor (name, address, phone):

{name}

Person(s) to be notified in case of emergency (other than parent/guardian):

Relationship

Telephone (evening and daytime)

Address

Home Address, City, State, Zip Code

{name}

Alternate Emergency Name

Relationship

Telephone (evening and daytime)

I understand that I will be contacted if there is a medical emergency. In the event I cannot be reached, I hereby authorize Fond Du Lac Children's Chorale or their appointed representative to sign for care.

Signature of Parent/Guardian, Date

School (Name, District)

Grade (in September 2023)

Are you in choir at school?

Are you in a church choir?

Are you in a band at school?

If yes, what instrument(s)?

{name}

Have you taken voice or instrument lessons?

If yes - What instrument? How long? Teacher?

{name}

T-Shirt Size

What other activities are you involved in (school, church, clubs)?

Any scheduling conflicts?

{name}

By signing my child up for Fond Du Lac Children's Chorale I consent to: 1. Photos and video may be taken of my child and used for marketing purposes. 2. I will make every effort to volunteer, contribute or assist THELMA staff as needed for concerts and for fundraising opportunities for the Chorale. 3. Keep rehearsals a priority in my family's weekly schedule.

Signature of Parent/Guardian, Date

Annual Tuition is $300 for First Child, $225 for each Additional Child. Tuition must be paid in full by September 11. Payments may be made by credit card by calling 920.921.5410 or by check mailed to 51 Sheboygan St., Fond du Lac, WI 54935. Checks are payable to THELMA. Would you like to help another child participate in the Chorale? Consider a donation toward scholarships.

Donation Amount:

Alert