Dragonfly Choir Registration Form, Fall Semester 2024 (for 1st & 2nd grade BOY Singers) October 17th

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Dragonfly Choir Registration Form, Fall Semester 2024 (for 1st & 2nd grade BOY Singers) October 17th - December 13th

Welcome to Dragonflies! --for 1st & 2nd grade boy singers. There are no auditions for this choir, only registrations.

To register Girls in Kindergarten and 1st grades: https://docs.google.com/forms/d/e/1FAIpQLSeMrxs-GKFyywYqDPoMbhyTWwt54--ulvV_KoVFAMI7hLyKKA/viewform

To register boys in grades 3 - 6, and girls in grades 2 - 12:

https://docs.google.com/forms/d/e/1FAIpQLSfYt1obE6prSWL7xeLdksokhBNUSe5XzbzlywbJ0O_sJ-1ZAQ/viewform

For more information: www.wschoralacademy.org / wschoralacademy@gmail.com / (336) 922-4073

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E-Mail-Adresse *

Welcome to Dragonflies, our brand new choir for 1st & 2nd grade boys!

*Rehearsals are on Thursdays from 5:45 - 6:30 pm, at Centenary United Methodist Church (downtown next to the Public Library)

Today's Date *

JJJJ

How did you find out about us?

(please check all that apply)

School Flyer

Social Media (Facebook, Instagram, etc.)

Music Teacher Recommendation

Other

Pflichtfrage

First & Last Name of Singer *

Grade in School as of August *

Name of School *

Birthdate *

JJJJ

Main Contact Phone #, including Area Code *

Mailing Address (Street/PO Box) *

City and Zip Code *

Email Address(es) to send Chorus Information *

(Please separate email addresses with a comma)

Parent/Guardian 1: Full Name *

Parent/Guardian 1: Cell Phone *

Parent/Guardian 1: Place of Employment *

Parent/Guardian 1: Work Phone *

Parent/Guardian 1: Mailing Address if Different from Above

Parent/Guardian 2: Full Name

Parent/Guardian 2: Place of Employment

Parent/Guardian 2: Cell Phone Number (including area code)

Parent/Guardian 2: Work Phone

Parent/Guardian 2: (Mailing Address if Different from Above)

Other Emergency Contact: Name & Relationship to the Singer *

Another person, relative or other, who is actively involved with family assistance, such as transportation, childcare, etc. Please also list the relationship to the singer (grandparent, aunt, etc.)

Other Emergency Contact: Cell Phone *

Child's Medical Doctor and Emergency Contact Number *

Primary Health Insurance Policy Number & Company Name *

List Food or Medicine Allergies (or state "None" if there aren't any) *

Medications taking on an Ongoing Basis

Please list any conditions or special needs of which WSCA should be made aware to help support your child for full success in the group. *

Including ADD/ADHD, Aspergers, Diabetes, etc. (this information is kept fully confidential)

STATEMENT OF MEDICAL RELEASE *

I HEREBY GIVE MY PERMISSION TO THE Winston-Salem Choral Academy Personnel and/or qualified medical personnel to act on my behalf in securing and administering all necessary emergency care for my child.

Yes, I grant my permission.

Pflichtfrage

Pick-up Authorization List:

The following individuals, in addition to the guardians and emergency contact listed above, are authorized to pick up my student from Dragonfly rehearsals and events. Please separate names with a comma.

PHOTO/LIKENESS/IMAGES & PARTICIPATION RELEASE FORM *

Winston-Salem Choral Academy is permitted to use photo and video images of my child taken during the program for publicity purposes (WSCA website, newsletters, flyers, etc.). I understand that the chorus has exclusive rights to all image(s) taken by WSCA on or off-site. Equally, I attest that no payment has been negotiated and that I am providing my consent without the expectation of payment now or in the future. In consideration of the benefits to be derived, and having confidence that reasonable precautions will be taken to ensure the safety and well being of my child, I hereby agree to her participation, and waive all claims against the directors, staff, and volunteers.

I give my permission for the chorus to use my child's photo/likeness/image as stated above.

I do not grant my permission.

Pflichtfrage

PERMISSION FOR RELEASE OF INFORMATION *

I grant my permission to include our contact information in the chorus roster that will be sent ONLY to chorus personnel and chorus families. I understand that this information will be treated confidentially and given only with my permission. (This is to be able to contact other parents for the purpose of carpooling, parent volunteer information, etc.)

I grant permission to include the above information in the chorus roster for chorus sharing purposes.

I do not grant my permission to include any of the above information in the the chorus roster to be sent. I understand only my child's name will be listed.

Pflichtfrage

Payment Information:

$50 Registration Fee and $85 tuition payment, total of $135.00 due by October 1st.

You can opt to register for BOTH the Fall and Spring Semesters for a discount; $82 registration Fee, $82 due by September 1st; third payment of $82 due by November 1st.

(Spring Semester is March 20th - May 6th)

An invoice will be sent via PayPal for payments due, and can be paid by either check or money order. Checks can either be brought to a rehearsal or mailed to 4105 Sewanee Drive, Winston-Salem, NC 27106. Please note postmark deadlines. Class size is limited; your child's space is guaranteed with deposit only.

I want to register for the Fall Semester Only

I want to register for BOTH the Fall and Spring Semesters

Pflichtfrage

Invoicing Information *

An invoice will be sent via Paypal for payments due, and can be paid by either check or money order. Checks can either be brought to a rehearsal or mailed to 4105 Sewanee Drive, Winston-Salem, NC 27106. Please note postmark deadlines. Class size is limited; your child's space is guaranteed with deposit only.

I understand the fees as listed in the brochure and that there is a processing fee for online payments.

I understand there are no refunds.

I would like more information regarding payments.

Pflichtfrage

Need more information? Call us at (336) 922-4073, or email at wschoralacademy@gmail.com, or visit our website at www.wschoralacademy.org.

Please make sure to add "wschoralacademy@gmail.com" to your email so you can receive reminders! (You may need to check your SPAM folder)

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