The Salvation Army Music and Creative Arts Registration

Child's Name*

First NameLast Name
Grade*
Date of Birth*

MonthDayYear
Date
Child's Age*
Name of Parent or Legal Guardian*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Emergency Contact Name (other than parent/guardian listed above)*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Other persons authorized to pick up your child (Yourself and the emergency contact are already included in this authorized list of pick-ups.) Your child will only be released to people on this list. Those on this list must present a picture ID in order for your child to be released into their care.
Name of person authorized for pick up.*

First NameLast Name
Phone # *
Dinner (5:00-5:30pm)
Will your child be eating dinner on Tuesday nights from 5:00 - 5:30pm?

YesNo
TROOPS (5:30-6:15pm)
Select which TROOPS group your child will participate in*

Sunbeams (girls, grades 1-5)Explorers (boys, grades 1-5)Girl Guards (girls, grades 6-12)Rangers (boys, grades 6-12)
Music and Creative Arts (6:15-6:45pm)
Music and Creative Arts FIRST Option*

GuitarBrass (must be 8 years old)Timbrels (Tamborine)Buckets (Percussion)ArtUkulele
Music and Creative Arts SECOND Option*

GuitarBrass (must be 8 years old)Timbrels (Tamborine)Buckets (Percussion)ArtUkulele
Music and Creative Arts THIRD Option*

GuitarBrass (must be 8 years old)Timbrels (Tamborine)Buckets (Percussion)ArtUkulele
Current Medications
Any medical conditions we should be aware of? If so, list them below
I hereby give permission for The Salvation Army personnel to provide emergency medical treatment, First Aid, and if necessary, to call 911 for my child. I understand my child may need to be transported to the nearest hospital if it is deemed necessary by paramedics. I also understand that The Salvation Army will do everything within their immediate power to contact me first.

I, understand and agree to the statements and permissions granted in this document in it's entirety.
Parent Legal Guardian Signature*

Clear
Parent/ Guardian Full Name*
Signed on This Date*

MonthDayYear
Date
By signing below, I give permission for my child to attend The Salvation Army's Music and Creative Arts Program starting September 23, 2025.
Date

MonthDayYear
Date
Parent/Guardian Full Name
Signature of Parent/Legal Guardian

Clear
Type a question
Should be Empty:

Dinner (5:00-5:30pm)

TROOPS (5:30-6:15pm)

Music and Creative Arts (6:15-6:45pm)