JVC Registration Form

STUDENT INFORMATION *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

PARENT/LEGAL GUARDIAN INFORMATION *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Contact Phone *

(###)

###

####

Phone Type *

Work

Cell

Home

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I understand that I am responsible for arranging the transportation of my child to and from all rehearsals and performances: *

I UNDERSTAND AND AGREE

I understand that Our Lady of Corpus Christi is not responsible for any loss or damage of personal property during rehearsals or performances. *

I UNDERSTAND AND AGREE

I understand that I am responsible for encouraging and supporting good and consistent independent practice at home so that my student(s) will be ready for their rehearsals and performances. *

I UNDERSTAND AND AGREE

EMERGENCY CONTACT INFORMATION *

First Name

Last Name

Phone *

(###)

###

####

Phone Type *

Work

Cell

Home

I affirm that this form has been filled out to the best of my knowledge and ability and that the information provided is correct. *

Acknowledge