Youth Choir Registration If you are a human and are seeing this field, please leave it blank. Youth's Name Gender Female Male Parent/Guardian School Grade Birthdate Address 1 Address 2 City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip / Post Code Phone Parent Email Musical Experience Do you play the piano? Yes No Do you play another instrument? Yes No Have you taken private lessons? Yes No What are some of your school activities? (Don't be shy.) What are some of your non-school activities? What do you do for fun? Allergies/Medical Information/Special Diet or Other Concerns My child is covered by health insurance Yes No Insurance Company ID/Member Number Names of People Who May Pick Up This Child Other Than Parent/Guardian Emergency Contact Name Emergency Contact Phone Please list any custody arrangements we need to be aware of. Enter your initials to sign this form electronically.