Form

Parent/Caregiver Information
Parent/Guardian Name *

First Name Last Name
Email *
example@example.com
Phone Number *
Please enter a valid phone number.
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Medical and Emergency Information
The following information is requested so that Marin Girls Chorus or their agents employed to support extra-curricular programs (e.g. teachers, directors, camp counselors, etc, known henceforth as “agents”) can make sensible decisions about administering basic medical care/first aid where necessary. For serious incidents, Marin Girls Chorus staff would of course act only on the advice of qualified medical personnel and every attempt would be made to contact you first.

However, should we or the medical staff be unable to contact you immediately, the information below will help us to make swift, informed decisions about the welfare of your child. Please fill out all boxes as completely as possible now. You are responsible for keeping the chorus updated of any changes to the information below, including contact numbers. For your child’s health and welfare, it is important that this form is as up-to-date as possible.
Primary Emergency Contact *

First Name Last Name
Primary Contact Phone Number *
Please enter a valid phone number.
Relationship to the singer *
Secondary Emergency Contact *

First Name Last Name
Secondary Emergency Contact Phone Number *
Please enter a valid phone number.
Relationship to Singer *
Health Insurance Company *
Health Insurance Policy Number *
Primary doctor's name and phone number *
Please list any allergies (food or otherwise):
Any pre-existing medical, social or emotional conditions you would like us to be aware of? *

Yes No
Details
I hereby give permission to the Marin Girls Chorus staff and their agents to authorize on my behalf any emergency medical care which, on the recommendation of qualified medical personnel, may be deemed necessary. In such circumstances, I understand that Marin Girls Chorus staff or their agents will seek to advise me at the earliest possible convenience. *

Yes No
Should be Empty:

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Marin Girls Chorus 2022-2023 Registration Form

Singer Information

Parent/Caregiver Information

Medical and Emergency Information