Rising Hope Children's Choir Registration Form

Parent 1
Name

First NameMiddle NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Work Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relation to the child
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent 2
Name

First NameLast NameSuffix
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Work Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
relation to the child
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Who do The Child Live with
Other Relationship

*Only the people add here and on the Parent can pick us the child
Relationship

Please List any Medical conditions that the Rise Hope Children’s Choir should be aware of: ( if yes please Explain and if not put N/A)

Do your child Experience any of the following (if yes please Explain and if not put N/A)

Does your child have a reaction to ( if yes, please explain and if not put N/A)

Other and Explain
Does your child have any condition that would prevent him/her in participation in any Activities?
If explain
Has your child been diagnosed with any mental health condition?
If explain
Does your child take any prescription Medications?
If explain
Please indicate any other pertinent information that the youth staff should know about your child:
Please list over the counter medication that you kids can take and note(s) that we need to know:
If an emergency should arise which requires immediate attention and we as parents/guardians cannot be contacted, we are authorized to take whatever steps are needed to protect the health of this child
Print Name
Signature

Parent Permission for Media Use for Rise Hope Children’s Choir
I, First Name Last Name Parent or legal Guardian of First Name Last Name hereby, Permission to the Rise Hope Children’s Choir to allow my child to be specially Photographed, Audio/ Videotaped, or interviewed in any way that would reasonably portray programs or events of the Rise Hope Children’s Choir The Rise Hope Children’s Choir retains the rights to any photographs, audio tapes or video recordings to be used for publicity or advertising in both print form and on the internet. I further release the Rise Hope Children’s Choir, and any of its employees or Board Members, from any compensation or damages in allowing the media’s use of photographs, audio/videotapes, or interviews of my child. The Rise Hope Children’s Choir is a nonprofit organization registered in the state of California. I do further certify that I am of full legal capacity to execute the above authorization and release.
Print Name
Todate
Signature
Should be Empty:

Parent 1