Community Choir
Dates: Mondays, January 11 - May
Time: 7-8:45pm
First Name
Please use a separate registration for each participant.
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Last Name
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Address
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City
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State
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Zip
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Contact Phone *
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Contact Email *
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Emergency Contact First Name *
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Emergency Contact Last Name *
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Emergency Contact Relationship
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Emergency Contact Phone *
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Medical Conditions/Learning Disabilities/Other helpful info
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Payment Method for registration fee *
Payment must be received one week before class.
Sliding Scale Payment
Please fill in the amount you will pay for your registration fee on a sliding scale of $10 - $35.
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Agreement and Release of Liability *
I hereby confirm that I have chosen to participate in the Unity Lutheran Church of Berwyn Awake program, including all planned and arranged activities. I am aware that this program may present risks of personal injury, property loss, or damage to participants. I accept all responsibility for any injury, death, or other loss or damage that may occur to me and/or to the minor I have enrolled as a result of my (or minor’s) participation in the Unity Lutheran Church of Berwyn Awake program. I release Unity Lutheran Church of Berwyn and will indemnify and hold harmless Unity Lutheran Church of Berwyn, its agents, affiliates, and successors from all claims, judgments, and costs, including attorney’s fees, incurred in connection with any action that may be brought as a result of my or the minor’s participation in the Unity Lutheran Church of Berwyn Awake program. I have read the Agreement and Release of Liability. I understand and agree to the terms.
Photography *
Awake may occasionally take pictures of participants for use in marketing material. I hereby consent to the use of my and/or my dependent's photograph in said marketing materials, including brochures, publications, presentations, and social media. Participants will not be named in these photographs.
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