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YOUTH INFORMATION
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First Name
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Last Name
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Date of Birth
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AGE
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GRADE
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School
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City
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State
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Zip
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Mailing Address
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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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CELL
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WORK PHONE
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FAX
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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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PARENT PERMISSION AGREEMENT
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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 Church, 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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TRANSPORTATION INFORMATION
Select all that applies
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PRIVATE
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WALKING
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PUBLIC
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REHEARSAL ATTENDANCE
Please check all that applies
We encourage attending two
or more rehearsals weekly
Sessions B, C, E are at NKC
Music Center beginning Sept 8
Sessions A, D are at Humboldt
School beginning Sep 15
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Session A / Tuesdays
7:45 AM - 8:25 PM
HUMBOLDT SCHOOL LIBRARY
4915 N Gantenbein
Portland, OR
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Session B / Tuesday
4:30 PM - 5:30 PM
NKC MUSIC CENTER
Ainsworth Community Christian Church
906 NE Ainsworth - Portland, OR 9721
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Session C / Wednesday
4:30 PM - 5:30 PM
NKC MUSIC CENTER
Ainsworth Community Christian Church
906 NE Ainsworth - Portland, OR 9721
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Session D / Thursdays
7:45 AM - 8:25 PM
HUMBOLDT SCHOOL LIBRARY
4915 N Gantenbein
Portland, OR 97217
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Session E / Thursdays
4:30 PM - 5:30 PM
NKC MUSIC CENTER
Ainsworth Community Christian Church
906 NE Ainsworth - Portland, OR 9721
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