Registration, General and Medical Waiver

The San Antonio Youth Chorale

Participant General and Medical Waiver
Participant Information
I am signing up for:

2025 Fall Season (August 17-September 28, 2025) ($25 Registration Fee)2025 Christmas Season (Begins October 26, 2025) ($25 Registration Fee)
Student's Name

First NameLast Name
Address

street address

Street Address Line 2

citystate

zip code
Student's Personal Email Address
example@example.com
Student phone
Birthday

MonthDayYear
Date
Current Age
Gender Identity
Preferred Pronouns
T-Shirt Size
School Name
Grade in School
What part do you Sing?

SopranoAltoTenorBassI don't know
Other muscial activities/instruments played?
Parent/Emergency Contact 1's Name
Parent/Emergency Contact 1's Phone Number
Parent/Emergency Contact 1's Email Address
example@example.com
Parent/Emergency Contact 2's Name
Parent/Emergency Contact 2's Phone Number
Parent/Emergency Contact 2's Email Address
example@example.com
Medical History & Information
Participants Physician
Phone
Physical conditions or limitations food or other allergies (asthma, diabetes, dysmenorrhea, headaches, hypertension, nervousness, seizures, lactose intolerance, or recent surgery or condition restricting walking, standing, sitting, movement, etc.)
Special Instructions (rare blood type, prohibited treatment, allergies to penicillin, latex, sulfa drugs)
List of medications taken regularly
Current Immunization:
Tetanus Date:
Polio Date:
None
Please include copy of current immunization record (Please upload copy or bring copy to first rehearsal.)

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Insurance Company
Policy Group Number
Name of Primary Insured
Please include copy of health plan identification card-front and back (Please upload copies or bring copies to first rehearsal.)

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MEDICAL TREATMENT APPROVAL & GENERAL WAIVER

In the event of an emergency necessitating medical attention, I hereby give my consent to the YouthCUE/SAYC staff and/or its representatives to make such decisions regarding treatment which is deemed necessary and proper under the circumstances.

I, the undersigned participant (or parent/guardian), do agree to indemnify and hold harmless YouthCUE/SAYC and/or its representatives from any and all actions, causes of actions, related risks and dangers, arising out of the treatment of any sickness or accident, and agree to assume financial responsibility for all medical treatment provided.

I, the undersigned participant (or parent or guardian), understand and acknowledge that not all students in the San Antonio Youth Chorale may have been immunized. I, the undersigned participant (or parent/guardian), do agree to indemnify and hold harmless YouthCUE/SAYC and/or its representatives from any and all claims and/or causes of action that may arise from exposure to students that are not immunized.
Signature of Adult Participant or Minor Participants Parent/Legal Guardian

Clear
Printed Name of Adult Participant or Minor Participants Parent/Legal Guardian
Date

MonthDayYear
Date
Should be Empty:

The San Antonio Youth Chorale

Participant Information

Medical History & Information

Current Immunization: