Student Registration Form for Rt. 4 Farm Tour National Anthem

National Anthem Battle Registration 2024

Battle for the Anthem at Benny's Pizza Pub and Patio
Parent/Guardian Info OR Adult Group Representative

If you are an individual, please provide your parent contact. If you are a group, please provide your organization's representative.
Name*

First NameLast Name
e-mail*
Primary Phone*

Area CodePhone Number
Cell Phone

Area CodePhone Number
Relationship to Student(s)*
Student Group/Representative Info

If you are an individual or group please indicate in the field below
Name/Student Group Name

First NameLast Name
Grade Level
Select the dates you are able and wish to battle for the chance to sing/perform at our events. THESE ARE BATTLE DATES.

June 6thJune 13thJune 20th
Are you able to perform the National Anthem for the Rt. 4 Farm Tour on the dates listed below? Select all that apply.

July 12th- Uptown Friday Nights-Wild Card EventJuly 18th- Jon Pardi at the Un. County FairgroundsSept. 14th- David Lee Murphy at the Un. County Fairgrounds
Notes:
Please upload a file or provide a link to showcase your qualifications and abilities to perform the National Anthem.

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Terms and Conditions
Today's Date

MonthDayYear
Date
By checking 'I Agree' below and submitting this form, you, the Parent or Guardian of the above student(s), agree to prepare your group or individual to perform the National Anthem LIVE at Benny's Pizza and Patio on the date selected. The Rt. 4 Farm Tour is not liable for any and all injuries which may occur while attending and performing at the battles or at the event in which they were chosen to perform. You also agree that you are responsible for the timliness and transportation (if necessary) for your group or individual if needed. You give permission for your student(s) to perform in front of a crowd in a competitive setting where nobody is guaranteed to "win" the event of their choosing. You also give your permission for the public display of any studio visual images that your child may appear in. You agree to hold harmless Rt. 4 Farm Tour for any and all damages and or injuries of any and all audio or video images.
please select*

I Agree
Should be Empty:

National Anthem Battle Registration 2024

Parent/Guardian Info OR Adult Group Representative

Student Group/Representative Info

Terms and Conditions