Registration Form: ECMI Youth Chorale
Thank you for your interest in the Ellsworth Community Music Youth Chorale!
A review of the offering and payment details...
ECMI Youth Chorale - Fall 2018

Wednesdays, Oct 10 - Dec 19, 2018 (no session Nov 21)
Moore Community Center | Ellsworth, Maine

ECMI Youth Chorale - to perform w/ Bagaduce Chorale
$75 per child (siblings $65)
One time fee for 10 sessions
6:30 - 7:30pm

Please complete a registration form for each child.

Payments may be sent via check to:

Ellsworth Community Music Institute
PO Box 56
Ellsworth, ME 04605

Alternatively, you may pay via cash/check/credit card at our registration desk on the first day - Oct 10

Please call us at: 207-664-9258 or email: info@ellsworthcommunitymusic.org with questions.

Student First Name *
Your answer
Student Last Name *
Your answer
Parent or Guardian First Name *
Your answer
Parent or Guardian Last Name *
Your answer
Emergency Contact 1 *
If same as parent listed above, please type "same"
Your answer
Emergency Contact Phone 1 *
If same as parent listed above, please type "same"
Your answer
Emergency Contact 2 *
Your answer
Emergency Contact Phone 2 *
Your answer
Parent Email *
If no email, please enter "N/A" and include phone below.
Your answer
Home Phone
Your answer
Mobile Phone
Your answer
Mailing Address 1
Your answer
City *
Your answer
State
Your answer
Zip
Your answer
Student Age
Your answer
Student Grade
Your answer
Student T-shirt Size
Your answer
Policies of Ellsworth Community Music Institute
SNOW POLICY
If the Moore Center is open, ECMI is open. The Moore Center does not necessarily follow school closings.

Please check www.ellsworthcommunitymusic.org or the ECMI Facebook page, or check for a cancellation notice on WLBZ Channel 2 or their website.

School Delays: Ellsworth Public Schools late starts do not affect ECMI classes.

PERMISSION FOR USE OF PHOTOGRAPHS AND VIDEO
Unless the student’s family submits a written request to the contrary, photographs of registered students taken during ECMI classes and events are considered eligible for publication and public use. All such student requests will be honored.

SAFE ENVIRONMENT POLICY
ECMI is committed to maintaining an environment where each individual who participates in its programs and attends its events feels safe, respected, and supported. Any individual whose behavior interferes in any way with that environment may, at the sole discretion of ECMI, be asked to withdraw from its programs.

DISCONTINUATION
ECMI reserves the right to discontinue a student’s enrollment at any time for reasons including, but not limited to: poor attendance, non-payment of fees, lack of interest or disruptive behavior.


Acknowledgement *
Required
Would you like to be on our mailing list?
We'll use the address that you've already provided.
Question/Message for ECMI
Your answer
If you would like a printed copy of your completed application, please print BEFORE pressing the submit button.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service