BAC Student Ambassador Program

Student Ambasssador Program Application

Student Information

* indicates required field

Title

Name*

First NameMiddle NameLast Name

Pronouns

Home Phone*

Please enter a valid phone number.

Email*

Confirmation EmailConfirm email address.

Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Name of school you currently attend*

Current grade in school*

Chorus/Band/Orchestra Teacher*

Primary Musical Instrument/Vocal Part*

Parent/Legal Guardian Information

Required for students under the age of 18.

If under the age of 18, Parent/Legal Guardian's Name

First NameLast Name

If under the age of 18, Parent/Legal Guardian's email address

example@example.com

If under the age of 18, Parent/Legal Guardian's phone number

Please enter a valid phone number.

Questions

What are your plans beyond CCHS, and what role do you imagine music/the arts will play?*

How do you plan to continue participating in the arts after high school?*

Essay Question #1: Describe the role of the arts in your life. (250 words maximum)*

0/250

Essay Question #2: Describe what the role of the arts could be within your community, or society more broadly. (400 words maximum)*

0/400

Media Release

By checking the appropriate box, I agree to allow photos and/or videos of myself during my participation in the Bach Akademie Charlotte Student Ambassador Program to be used by Bach Akademie Charlotte in print and online in perpetuity.*

Photo(s) OnlyVideo(s) OnlyPhoto(s) and Video(s)You may not use photos or videos of me

Hold Harmless & Signature

I hereby indemnify Bach Akademie Charlotte of any and all responsibility for any accident or injury incurred by me during the course of my participation in the Bach Akademie Charlotte Student Ambassadodor Program.

I acknowledge that my name and signature below constitute my legal electronic signature and my acknowledgment and acceptance of these terms.

Student Signature*

Parent/Legal Guardian Signature (if student is under 18)*

This form is hosted by jotform.com.
JotForm is a PCI DSS Service Provider Level I Compliant Provider.