Children's Choir Membership Form My child is participating in the:*Cherub (K - 2nd Grade)Agape (3rd - 5th Grade)Youth's Name* First Last Date of Birth* MM DD YYYY Age (this September)*Height*For Choir Robe.Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Member Of*Gables UCCSchool You Attend*Grade in School (this September)*Instruments Played (if any):Parents*Email* Home PhoneWork PhoneCell Phone*Media Release I give permission to use my child's name, photograph, and/or performance recordings (including audio and/or video forms) in brochure, web, and other promotional materials. Emergency Contact InformationFirst Contact Name* First Last Relationship to Child*Home PhoneCell Phone*Second Contact Name First Last Relationship to ChildHome PhoneCell PhoneEmergency Medical InformationName of Health Insurance Company*Policy Number** I authorize medical treatment for my child in case of accident or illness if the parent/guardian cannot be located and an emergency situation arises. Authorized Pick-UpWho can pick-up this child?* Mother Father Note: We CANNOT forbid any parent access to their child without a Court Order.The following individuals are authorized to pick-up my child:Note: Siblings under 18 years of age CANNOT sign-in or sign-out children.Name First Last Relationship to Child*Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneCell PhoneName First Last Relationship to ChildAddress Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneCell PhoneNote: We reserve the right to refuse anyone access to your child whose name is not listed.Parent's Digital Signature*Date* MM DD YYYY