After School Program

After School Program Registration
Parent/Guardian Info
Name*

First NameLast Name
e-mail*
Primary Phone*

Area CodePhone Number
Work Phone

Area CodePhone Number
Cell Phone

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Emergency Contact (If Parent/Guardian cannot be reached)*
Relationship to Student*
Emergency Phone*

Area CodePhone Number
Is your student(s) enrolled in Flint Community Schools?

YesNo
Will your student(s) need transportation to/from the program?

YesNoUnsure
Student Info
Student Name*

First NameLast Name
Date of Birth*

MonthDayYear
Age
Grade in School
Add Another Student?

Add Another Student
Student 2 Info
Student Name*

First NameLast Name
Date of Birth*

MonthDayYear
Age*
Grade in School
Add Another Student?

Add Another Student
Student 3 Info
Student Name*

First NameLast Name
Date of Birth*

MonthDayYear
Age*
Grade in School
Additional Information
Please include any additional information you would like us to know about your student(s).
Terms and Conditions
Today's Date

MonthDayYear
Date
I hereby grant permission for Voices of Flint Youth Chorus to use my student's image including the display, distribution, publication, or other use of photographs, electronic images, audio recordings and/or video recordings taken for use in materials including, but not limited to, printed materials such as newsletters, audio recordings, video recordings, and digital images such as those on the Voices of Flint Youth Chorus website or other internet locations. I agree that these images and recordings may be used for a variety of purposes and that these images. I also understand unless specified, my last name will not be used in conjunction with any audio or video recordings or digital images.

*If you do not grant photo permission, please leave the name boxes blank*
Parent/Guardian Name

First NameLast Name
By checking 'I Agree' below and submitting this form, you, the Parent or Guardian of the above student(s), agree to release Voices of Flint Youth Chorus, including instructors, assistants, and volunteers from liability for any and all injuries which may occur while rehearsing, practicing, performing, or during any program event or activity. You also agree that you are responsible for health and accident insurance and any medical costs incurred due to injury. You give permission for emergency medical transportation and treatment of your student(s) at your expense should the need arise. You also give your permission for the public display of any studio visual images that your child may appear in.
I Agree
Should be Empty:

After School Program Registration

Parent/Guardian Info

Student Info

Student 2 Info

Student 3 Info

Additional Information

Terms and Conditions