Music on a Mission 2018

Brooks Memorial Baptist Church's
PLEASE DO NOT USE THE BROWER'S BACK BUTTONS (THE NAVAGIATION BUTTONS).
ONLY USE THIS FORM'S BACK AND NEXT BUTTONS!!!!

Welcome!

We are so glad your child/children will be joining us for this year's Music on a Mission Camp. Please read over the following information before proceeding.

Please note that this form is for children living at the same address.

If you are registering children who have different contact information (i.e., different addresses, different parents, etc.), please register one child then start over and register the second child. There will be an option to share a choral book and listening CD with another child and you will still receive the multiple child discount.
- Please be sure to read through ALL the information at our website (Music on a Mission).
- Please be sure to complete this form in its entirety.
- Once registration is complete, you will receive an email. Please print this it and send it with your payment.
- If you have any questions, please feel free to email me at MusiconaMissionAtmore@gmail.com or call/text at 251.359.4086.
I have read through all the information on the Music on a Mission Website and this page. I understand what is expected from myself and my child/children and wish to register them for Music on a Mission Camp 2018.*

Yes

Your Information
Your Name*

First NameLast Name
Your Email Address*
How many children are you registering?*
Does each child live at the same address?*

YesNo
Will your children be sharing a choral book and listening CD with another child that lives at a different address?

YesNo
Please list the child's name that will be sharing the choral book and listening CD:
Since you are registering children that live at different addresses, please be sure to complete a seperate registration for each child at these different addresses. If you would like for these children to share a book and CD, they can still recieve the mulit child discount. In order to receive this discount, please email (MusiconaMisisonAtmore@gmail.com) me the name of the children and I will send you the final payment amount.

Audition Information
The following kids would like to audition for a speaking part and/or solo/duet:
Child's Name
Child's Name
Child's Name
Child's Name
Child's Name
If your child receives a speaking part or solo/duet, the information will be in their camp packets. If your child receives a speaking part, there will be a script with the part highlighted. If they receive a solo/duet, the part will be highlighted in their choral book. We also require that they learn their part before camp. We have limited time to learn things during camp and need to begin staging the first day. Finally, if your child receives a part, they are REQUIRED to be at camp each day, all day, and at the performance on Friday.

When assigning parts, we begin with the oldest campers that auditioned and then move to younger campers. We would love to give everyone a part, but there are limited spots. For anyone that auditions, we are very proud of them. It is so hard to even audition for something. We would like to encourage everyone, whether they got a part or not, to continue to tryout each year.

Please agree to the following statement:

I have read and understand what is required of my child when auditioning for a speaking part or solo/duet. I understand they must be at camp each day, all day and at the performance on Friday, July 21st at 6:30pm. I also understand how parts are assigned. I agree to pick up my child's camp pack early enough for them to learn their part if they are to recieve one.
Digital Signature
Date

MonthDayYear

Medical Release/Liability Waiver AND Photography/Video Permission
Relationship to Child/Children*
NOTE: This must be completed by the parent/guardian. If you are not the parent/guardian for this child, please use the printable Medical Release & Liability Waiver/Photography & Video Permission for the parent/guardian to complete.
Medical Release Libality Waiver

I, hereby give employees and volunteers of Brooks Memorial Baptist Church permission to provide first aid care for my child/children which I am registering. In the event I cannot be reached, I hereby authorize Brooks Memorial Baptist Church's employees and/or volunteers to transport my child to the emergency room, and I hereby grant my consent for the hospital and its medical staff to provide my child with emergency medical treatment that a physician deems necessary (including anesthesia). My child/children may be taken to and cared for at the nearest hospital, and I agree to accept all financial responsibility for all medical expenses incurred.

I, on behalf of myself and my child, our personal representatives, heirs and assigns, release and covenant to hold harmless Brooks Memorial Baptist Church, its employees, volunteers, and agents from all demands, claims, and causes of action I or the child may have for personal injury, property damage, economic loss, or emotional distress, or otherwise, arising from, or in any way relating to, this activity.

I have carefully read the foregoing permission/release, know the contents there of, and sign the same as my own free act.

Photography/Video Permission

I give permission for photos, videos, and the likeness of the following child/children to be utilized for historical and/or advertising/public relations for Brooks Memorial Baptist Church without remuneration for said likeness for my child/children which I am registering.

Child/Children's Medical Information

Child #1
NOTE: You may enter the Chid's Doctor's Name, Insurance Provider, and Policy Number once, if the information is the same for each child.
Child's Name
Child's Doctor's Name
Insurance Provider
Policy Number
Please list any medical concerns, allergies, and/or medications that we need to be aware of:

End Child #1

Child #2
Child's Name
Child's Doctor's Name
Insurance Provider
Policy Number
Please list any medical concerns, allergies, and/or medications that we need to be aware of:

End Child #2

Child #3
Child's Name
Child's Doctor's Name
Insurance Provider
Policy Number
Please list any medical concerns, allergies, and/or medications that we need to be aware of:

End Child #3

Child #4
Child's Name
Child's Doctor's Name
Insurance Provider
Policy Number
Please list any medical concerns, allergies, and/or medications that we need to be aware of:

End Child #4

Child #5
Child's Name
Child's Doctor's Name
Insurance Provider
Policy Number
Please list any medical concerns, allergies, and/or medications that we need to be aware of:

End Child #5

Parent/Guardian Information
Parent/Guardian #1*

First NameLast Name
Cell Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
E-mail
Church Attendance?*

YesNo
Church Name
Parent/Guardian #2

First NameLast Name
Cell Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
E-mail
Church Attendance?

YesNo
Church Name
Home Phone

Area CodePhone Number
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Is your mailing address the same as your physical address?*

YesNo
Physical Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Emergency Contact Information
1st Person to Contact*

First NameLast Name
Relationship to child*
Cell Phone*

Area CodePhone Number
Other Number

Area CodePhone Number
2nd Person to Contact

First NameLast Name
Relationship to child
Cell Phone

Area CodePhone Number
Other Number

Area CodePhone Number
3rd Person to Contact

First NameLast Name
Relationship to child
Cell Phone

Area CodePhone Number
Other Number

Area CodePhone Number

Payment Information
Please select one:*

I am able to make a donation to help cover the cost of Music Camp.I am unable to make a donation to help cover the cost of Music Camp.

Donation Amount
Donation Amount
$

Unidad Educativa Eben-Ezer Bolivia
At Eben-Ezer, we will strive to provide a safe home and learning environment for those escaping situations of abuse and domestic violence. With nearly 80% of Bolivian children facing physical, psychological, and/or sexual abuse in their homes, (there is a dramatic need for such safe havens) the need for such safe havens is paramount.
Would you like to donate to Unidad Educative Eben-Ezer Bolivia with this registration?

Yes, I would like to make a donation to Familia Feliz.No, I do not wish to donate to Familia Feliz at this time.
Familia Feliz Donation

Review Payment Due
Please review the information below. If there is an error, please go back and review the information entered. If all the information is correct and there is still an error, please complete this registration form and send me an email at MusiconaMissionAtmore@gmail.com AND print and make any corrections on the PDF that will be linked in your confirmation email. I will make the necessary changes on our end.

PLEASE DO NOT USE THE BROWER'S BACK BUTTONS (THE NAVAGIATION BUTTONS). ONLY USE THIS FORM'S BACK AND NEXT BUTTONS!!!!
Camp Donation Amount
Familia Feliz Donation
Total Due

Donation
Donation Amount
Below is the amount due for your child/children's registration. Please print out your confirmation email and turn it in with your payment. You can turn it in to the church office, Jeremy Jones, Tiffany Jones. You may also mail it to:

ATTN:Jeremy or Tiffany Jones
Brooks Memorial Baptist Church
904 McRae St.
Atmore, AL 36502
Amount Due

Collapse End (Donation Note)

Thank You for registering
We look forward to seeing each camper at Music on a Mission Camp this year. Please let us know if you have any questions, comments, or concerns. You can call/text me at 251.359.4086 or email me at MusiconaMissionAtmore@gmail.com.

Also, if paying by check, please makesure to put Music on a Mission and your child/children's name(s) in either the memo line or comment box.

Thank you again for allowing us to work with your child/children. This is such a blessing to us each year.

In Christ,

Tiffany S Jones
Note/Comments:
Should be Empty:

Brooks Memorial Baptist Church's

Your Information

Audition Information

Medical Release/Liability Waiver AND Photography/Video Permission

Medical Release Libality Waiver

Photography/Video Permission

Child/Children's Medical Information

Parent/Guardian Information

Emergency Contact Information

Payment Information

Unidad Educativa Eben-Ezer Bolivia

Review Payment Due

Donation Amount

Thank You for registering