Madison Youth Chorus Enrollment Form

COME SING WITH US! 
The chorus is open to students in grades 3 – 8.  Students will learn correct vocal techniques, stage etiquette, solfege, sight reading and music theory. Different styles of music will be learned and performed. 
-  Rehearsals are every Monday from 5:30pm - 6:30pm and begin January 9, 2012 for the Spring Semester-  Rehearsals will be held at the Richmond Area Arts Center on 399 W. Water Street
-  Tuition is $30

- Director is Deborah Kidd
-  The Madison Youth Chorus Winter Concert will be held on December 5th, 2011 beginning at 7:00pm at the Richmond Area Arts Center

To register, complete the form below. 
 

Name of Youth: *

Age: *

Grade: *

Birthdate: *

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Street: *

City: *

Zip: *

Home Phone: *

Cell Phone: *

Mother / Guardian: *

Mother's Home or Cell Phone: *

Mother's Work Phone: *

Father / Guardian: *

Father's Home or Cell Phone: *

Father's Work Phone: *

INFORMATION REQUIRED IN CASE OF AN EMERGENCY

Emergency Contact: *

Emergency Contact Home Phone: *

Emergency Contact Cell Phone: *

Emergency Medical Consent for Treatment of Minors: *

In the event of a medical emergency related to the minor child listed above, I hereby request Pattie A. Clay Hospital to contact me at the telephone number(s) listed below. In the event I, or my spouse, are unavailable, I hereby give my written consent to Pattie A. Clay Hospital, or any other hospital, to render whatever emergency medical care may be deemed appropriate by the hospital's emergency medical staff, until I or my spouse may be contacted. The following providers are not employees of the hospitals, but are instead independently contracted to provide services for the patient, and are legally responsible for their actions: All physicians, including E.R. physicians, pathologists, technical and professional components, radioolgists, anesthesiologist, and therapists.

Medication Allergies:

Seasonal Allergies:

Food Allergies:

Medications being taken:

Date of Last Tetanus Shot: *

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Date of Last Immunizations: *

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List Any Special Medical Conditions:

Parent/Legal Guardian: *

Relationship: *

(note: only parents or legal guardians can authorize emergency medical treatment)

Email Address: *

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