KCC Registration 2024-25

SINGER REGISTRATION & MEDICAL RELEASE
Select at least one

New AuditionAuditioning for Step-upChorusChoraleConcertCantamusRemove from Choir
Please complete this form to ensure your 2024-2025 place in the choir.

Please note that your registration is not complete until full payment has been submitted. This fee can be applied towards KCC tuition for the 2024-2025 season, should the singer return to the KCC/audition successfully.

Registration will close on July 31, 2024, or when 200 singers have registered (whichever comes first!). To register, please submit this completed form and payment (checks made payable to Kettering Children’s Choir) to:

Kettering Children Choir
P.O. Box 292202
Kettering, OH 45429

Or preferred payment is online

https://form.jotform.com/ketteringcccfo/Payments
Singer's Name

First NameLast Name
If New, who referred singer?

First NameLast Name
Birth Date

MonthDayYear
School in the Fall
Grade in the Fall
Music Teacher
Singer's Musical Experience Years of School Choir
Years of Community Choir
Years of Private Lessons and Type
Exmple: 5 Year piano lessons
Gender

MaleFemaleNon-Binary
Singers Voice Type

AltoTenorBassSoprano
T-Shirt size (if you are new to KCC or need a new one)

Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult Large
Address

Street Address

Street Address Line 2

CityState

Zip Code
Diversity: The KCC applies for grants throughout the year to supplement our income to support different projects. Several of these grants ask questions regarding diversity. We ask that you write what you feel appropriate based on your childs diverse background to help us characterize our choir.
Childs Diversity Characteristics
Provide any words that would help us describe the diversity of our choir
Parent/Guardian/Singer and Additional Contact Information
Name

First NameLast Name
Relationship
Ex: Mother or Step Mother
Phone Number
E-mail
example@example.com
Name

First NameLast Name
Relationship
Ex: Mother, Father or Step Father or Grandmother
Phone Number
E-mail
example@example.com
Name

First NameLast Name
Relationship
Ex: Singer
Phone Number
E-mail
example@example.com
Singer lives with
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Alt. Phone Number
Physician

First NameLast Name
Phone Number
Dentist

First NameLast Name
Phone Number
Does the singer have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is the singer prescribed an inhaler? If yes, please explain any instructions.
Insurance Carrier
Policy/ID#
Medical Release and Authorization

In the unlikely event that my child becomes ill or is injured, and I, or the authorized physician named, cannot be immediately contacted at the time of an emergency, and if in the judgment of the staff of the Kettering Children’s Choir immediate observation or treatment is necessary, I authorize and direct the staff to send my child (properly accompanied) to the hospital or physician most easily accessible. I release the Kettering Children’s Choir, their employees, and agents from any claim of liability in connections therewith.
PHOTOGRAPHIC RELEASE

The undersigned agrees without compensation to permit The Kettering
Children’s Choir, its agents, assignees and employees to use photographic
images or likenesses of the below listed singer(s) for use and benefit of
The Kettering Children’s Choir in its publications and other organizational
development and promotional programs. This release shall continue in
force until specifically revoked.
Commitment Statement

WE UNDERSTAND THAT THE SINGER IS MAKING A FULL-YEAR COMMITMENT AND AGREE TO PARTICIPATE FOR THE ENTIRE SEASON. WE ALSO UNDERSTAND THAT WE ARE MAKING A FINANCIAL COMMITMENT FOR THE COMPLETE TUITION RATE, WHICH IS NON-REFUNDABLE.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Type a question
Signature of Parent or Guardian*

Clear
Signature of Singer

Clear
Should be Empty:

SINGER REGISTRATION & MEDICAL RELEASE