Enroll in Music Program

Student Name *

Primer Nombre

Apellido

Gender or Pronouns

Birthdate *

Student's Preferred Language *

Please choose the ethnicity that best describes the student (this information will ONLY be used for statistical purposes. It will NOT be used as a basis for admission or any other discriminatory manner) *

If you indicated "other" please specify below

Address *

Address Line 1

Address Line 2

City

State

Zip Code

School *

Student Grade *

Student's Living Arrangement *

Does the student qualify for free or reduced lunch? *

Yes
No

Parent/Guardian #1

Name *

Primer Nombre

Apellido

Cell Phone Number *

Work Phone- if applicable

Email *

Parent 1 Preferred Language *

Do you feel comfortable communicating in English? *

Yes
No

Address- leave blank if same as student address

Address Line 1

Address Line 2

City

State

Zip Code

Parent/Guardian #2

Name

Primer Nombre

Apellido

Cell Phone

Email

Parent/Guardian 2 Language Preference

Do you feel comfortable communicating in English?

Yes
No

Address- leave blank if same as student address

Address Line 1

Address Line 2

City

State

Zip Code

People Authorized for Pick-Up

Please list who is authorized to pick-up your child. By law, we cannot release your child to someone who is not a parent or legal guardian unless you have given us prior written authorization to do so.

Name

Primer Nombre

Apellido

Phone

Name

Primer Nombre

Apellido

Phone

Emergency Information

Emergency Contact #1 (other than parent or guardian) *

Primer Nombre

Apellido

Cell Phone Number *

Emergency Contact #2 (other than parent or guardian)

Primer Nombre

Apellido

Cell Phone Number

Please list any allergies or medical conditions your child has.

May your student be given the following if needed?

Aspirin or Tylenol *

Benadryl *

Medical Authorization

Should it be necessary for the student, parent(s), and/or guardian listed above to receive medical care while participating with Global Arts and/or any activities with which it is affiliated, I/we hereby give Global Arts personnel permission to use their judgement in obtaining that care. I/We also give permission to the physician selected by Global Arts personnel to render medical care that s/he deems necessary and appropriate. I/We understand that Global Arts has no insurance covering medical or hospital costs incurred by any participant and, therefore, any cost incurred for such treatment will be entirely my/our responsibility.

I agree- Parent/Guardian #1 Signature *

I agree- Parent/Guardian #2 Signature

Join Our Music Program

Parent/Guardian #1

Parent/Guardian #2

People Authorized for Pick-Up

Emergency Information

Medical Authorization

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