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CoachArt Sibling Registration
To enroll the sibling (between the ages of 5-18) of a chronically ill child, please provide their information below.
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* Indicates required question
Parent/Guardian: First and Last Name
*
Your answer
Parent/guardian mobile number
*
Your answer
Parent/Guardian: Email Address
*
Your answer
Address to ship lesson supplies to:
*
Your answer
What is the name, age and diagnosis of the child in the family who has a medical condition?
Your answer
Sibling 1: First and Last Name
*
Your answer
Sibling 1: Date of Birth
*
MM
/
DD
/
YYYY
Sibling 1: Gender
*
Female
Male
Prefer not to say
Other:
Sibling 1: Activity Preferences
*
Check all that apply
Visual Arts
Sports
Performing Arts
Music
Literary Arts
Culinary Arts
Required
Sibling 1: Please list any specific activities your child would like
Example: Piano, Soccer, Photography
Your answer
Sibling 1: Allergies and any relevant medical information
Your answer
Sibling 1: Please describe your child to help our coaches get to know them. e.g. Gabriella takes time to warm up to new people. She loves Pokemon and singing.
*
Your answer
Sibling 1: Please let us know the best days of week and times of day for 1:1 lessons for your child
*
Your answer
Would you like to add additional sibling?
*
Yes
No
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