Balladeer Children's Program Enrollment

Balladeer Children's Program Enrollment

The Balladeer Children's Program is ONLY open to Ballad Health direct hires with a child between the ages of three through eighteen. NOTE: You MUST be enrolled in the Balladeer Children's Program in order to participate in the program's events. If you have multiple children, the form must be filled out for EACH child separately.
Team Member Name:*

First NameLast Name
U Number (Team Member ID):*
Do NOT use a U in front of team member number.
Please click the box below to confirm that you are direct hire of Ballad Health. As a reminder, only Ballad Health direct hires are eligible for the Balladeer Children's Program at this time. A direct hire is an employee who is on the payroll for Ballad Health. If you work for a contracted agency or are a resident, you do not qualify at this time.*

Yes, I confirm that I am a direct hire of Ballad Health and am eligible to join.
Please check here ONLY if you are re-enrolling a child from the former enrollment platform. If you are enrolling a new child, please do not check this box.

I am re-enrolling this child.
Please check here ONLY if you are a new hire of Ballad Health and have been employed for six months or less.

I am a new hire.
Team Member Employment Location (please choose the closest option available; if your position is hybrid, please select the option that reflects your in-person location): *
Email:*
example@example.com
Phone Number:*
Please enter a valid phone number.
Home Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Team Member Employment Location: *
Years of Service:*

< 1 year1-5 Years6-10 Years11-15 Years16-20 Years21+ Years

Child's Name Being Enrolled:*

First NameLast Name
Gender of Child:*

BoyGirl
Age in Years (MUST BE AT LEAST 3 AT THE TIME OF ENROLLMENT TO BE ELIGIBLE):*
Age in Years (MUST BE AT LEAST 3 AT THE TIME OF ENROLLMENT TO BE ELIGIBLE):*
Note: The Balladeer program is intended for ages 3 through 18.
Birthdate of Child: *

MonthDayYear
Date
By clicking below, you verify that the child you are enrolling is at least 3 years old as of today's date AND lives in the same household as you.*

Yes, my child is at least 3 years old as of today and lives in the same household as me.
Child's T-Shirt Size:*

Liability Release Form:

Please read the following document and fill out the boxes below. You must fill this out before you will be allowed to participate in any Balladeer Children's Program events from July 1, 2024 to June 30, 2025.
Name of child and parent/guardian:*
Your relationship to the child participating in the Balladeer Children's Program: *
Parent/Guardian Name: *

First NameLast Name
Parent/Guardian E-mail:*
example@example.com
Please review this document before signing below.
Please read the following statement and check the box.*

I confirm I am over age eighteen (18), I am the parent/legal guardian of the Balladeer Participant referenced above, and I have read and agree to the terms of the Balladeer Children’s Program Participant Consent Form.
If you don't want your photos taken and used, please click the box below.

I do not consent to have photos taken of me, or my family. I am choosing to opt out of this portion of the above waiver. My signature below applies to the section regarding liability.
Signature of parent/legal guardian: *

Clear
Date:*

MonthDayYear
Date
Should be Empty: