Mic Check Music Program Registration Form 🎶✨

Mic Check Music Program Registration Form 🎶✨

Register for the year-round Mic Check Music Program starting April 1, 2026. Limited to 25 participants, apply now!
Participant Information
First Name*
Last Name*
Date of Birth*

MonthDayYear
Date
Age*
Gender

FemaleMaleNon-binaryPrefer not to sayPrefer to self-describe
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Home Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
School / Current Educational Status
Employment Status
City, State, and ZIP Code*
Emergency Contact and Referral Source
Emergency Contact Name*

First NameLast Name
Relationship to Participant*
Emergency Contact Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Preferred Method of Contact

PhoneText MessageEmailAny of the Above
How did you hear about the program?
Eligibility and Program Acknowledgments
Confirm eligibility and acknowledgment*

I confirm the participant is between 17 and 24 years old.I understand space is limited and submission does not guarantee acceptance if the 25-participant limit has already been reached.I confirm availability for a year-round program starting April 1, 2026.
Program capacity acknowledgement*

I understand the program accepts up to 25 participants and my submission may be waitlisted or not accepted if capacity is reached.
Program schedule availability*

I confirm I am available to participate in a year-round program beginning April 1, 2026.
Music Interests and Participation Needs
Musical Interests*

RecordingSongwritingPerformanceProductionEngineeringOther
Prior Music Experience
Preferred Area of Focus*
Goals for Joining the Program*
Support or Accessibility Needs
Transportation Needs
Medical or Allergy Information Relevant to Participation
Additional Comments
Participation Consents
I understand and agree to the participation expectations*

Yes
I consent to the use of photos, audio, and video taken during program activities

Yes
I authorize emergency medical treatment if I am unable to provide consent at the time of an emergency*

Yes
Minor Guardian Consent and Signature
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email*
example@example.com
Parent/Guardian Signature*
Participant Signature and Date
Participant Signature
Date*

MonthDayYear
Date
Should be Empty:

Mic Check Music Program Registration Form 🎶✨

Participant Information

Emergency Contact and Referral Source

Eligibility and Program Acknowledgments

Music Interests and Participation Needs

Participation Consents

Minor Guardian Consent and Signature

Participant Signature and Date