The Salvation Army Music and Creative Arts Registration

The Salvation Army Music and Creative Arts Registration

Starting Tuesday, January 14 we will be offering our Tuesday night music and creative arts programs. The schedule will be as follows: 5:00 - 5:30pm Dinner 5:30 - 6:00pm Music and Creative Arts Classes 6:00 - 6:30pm Singing Company (Youth Choir) All youth staying after 6:00pm will be required to participate in Singing Company. If your child does not want to participate, then pick up will either be at 5:30pm or 6:00pm. Select your child's 1st, 2nd, and 3rd choices for the music and creative arts class that will be offered. Please note that selections are not guaranteed, and your child may or may not receive their 1st choice. All classes have limited capacity. *** If you have more than one child, please complete a form for each child. ***
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 # *
Will your child be eating dinner on Tuesday nights from 5:00 - 5:30pm?

YesNo
Music and Creative Arts FIRST Option*

GuitarBrass (must be 8 years old)PuppetsArtPiano
Music and Creative Arts SECOND Option*

GuitarBrass (must be 8 years old)PuppetsArtPiano
Music and Creative Arts THIRD Option*

GuitarBrass (must be 8 years old)PuppetsArtPiano
Will your child be participating in Singing Company (Youth Choir) from 6:00 - 6:30pm?

YesNo
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
I hereby grant The Salvation Army (TSA) and any of its assigns or agents the unrestricted right to print, publish, copyright or otherwise use, for any purpose, my child's image whether through photo or video as often as TSA deems necessary. This includes any photograph, art- work or other representation of my child, in which they may appear. At its discretion, TSA may use my child's image in any advertisement, display or publication. I grant TSA this right with the understanding that I will not receive any type of payment for their use of such media.
By signing below, I give permission for my child to attend The Salvation Army's Music and Creative Arts Program starting January 14, 2025.
Date

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

Clear
Should be Empty: