YOUTH INFORMATION
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DATE OF BIRTH
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FIRST NAME
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AGE
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GRAD
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LAST NAME
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SCHOOL
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HOME ADDRESS
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ZIP
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STATE
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CITY
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PRIMARY PARENT/GUARDIAN INFORMATION
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PRIMARY PARENT/GUARDIAN NAME
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HOME PHONE
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WORK PHONE
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CELL
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FAX
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EMAIL
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SECONDARY PARENT INFORMATION - optional
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SECONDARY PARENT/GUARDIAN
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CONTACT PHONE
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EMAIL
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EMERGENCY INFORMATION
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EMERGENCY CONTACT NAME
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EMERGENCY CONTACT PHONE
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RELATIONSHIP TO CHILD
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PARENTAL PERMISSION
In consideration of the wholesome recreational and learning experience in which my child will participate, I as parent/guardian of my child do hereby agree to
allow my child to participate fully in the No! Kidding! Choir Where Kids Are Winners—which includes my child attending two or more choir rehearsal sessions
weekly, performances, and special activities. In consideration of the opportunity for my child to participate in the Program, I agree to RELEASE, HOLD
HARMLESS, AND INDEMNIFY— Ainsworth Community Christian Association, the No! Kidding! Choir Where Kids Are Winners, and all their agents, servants
and employees from any liability, claims, demands and causes of action arising out of or relating to any loss, damage or injury sustained in connection with or
arising out of my child’s participation in the Program. I further understand that as parent/guardian I am responsible for my child’s transportation to and from
all rehearsals, activities, and performances.
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After reading the above Parental Permission, I give my child permission to
participate in the No! Kidding! Choir
PARENT/GUARDIAN AUTHORIZING THIS PERMISSION TO
PARTICIPATE
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TRANSPORTATION INFORMATION
My child’s general mode of transportation - please "X" all that applies
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WALKING
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PRIVATE
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PUBLIC
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PARTICIPATION INFORMATION
We suggest children attend two or more rehearsal sessions weekly - please "X" all that applies
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Session A
4:30 PM - 5:30 PM
Ainsworth Community Christian Association
906 NE Ainsworth - Portland, OR 97211
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Session B
3:00 PM - 4:00 PM
Humboldt School
4915 N Gantenbein - Portland, OR 97217
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Session C
4:30 PM - 5:30 PM
Ainsworth Community Christian Association
906 NE Ainsworth - Portland, OR 97211
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Session D
4:30 PM - 5:30 PM
Ainsworth Community Christian Association
906 NE Ainsworth - Portland, OR 97211
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