Join Our Music Program Please enable JavaScript in your browser to complete this form.Student Name *Primer NombreApellidoGender or PronounsBirthdate *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Student'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) *Latino(a) or HispanicBlack or African-AmericanAsianPacific IslanderCaucasian/WhiteOtherIf you indicated "other" please specify belowAddress *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeSchool *Student Grade *Student's Living Arrangement *Living with ParentsLiving with other family membersFoster care/parentsLiving by themselfOtherDoes the student qualify for free or reduced lunch? *YesNoParent/Guardian #1 Name *Primer NombreApellidoCell Phone Number *Work Phone- if applicableEmail *Parent 1 Preferred Language *Do you feel comfortable communicating in English? *YesNoAddress- leave blank if same as student addressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeParent/Guardian #2NamePrimer NombreApellidoCell PhoneEmailParent/Guardian 2 Language PreferenceDo you feel comfortable communicating in English?YesNoAddress- leave blank if same as student address Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePeople Authorized for Pick-UpPlease 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.NamePrimer NombreApellidoPhoneName Primer NombreApellidoPhoneEmergency InformationEmergency Contact #1 (other than parent or guardian) *Primer NombreApellidoCell Phone Number *Emergency Contact #2 (other than parent or guardian)Primer NombreApellidoCell Phone NumberPlease list any allergies or medical conditions your child has. May your student be given the following if needed?Aspirin or Tylenol *Yes NoBenadryl *Yes NoMedical 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 *Clear SignatureI agree- Parent/Guardian #2 SignatureClear SignatureSubmit