Chorus Registration Form – Students 18 and Under

Chorus Registration Form - 18 and Under

Name*
First Last
Voice Part*
Address*
Street Address Address Line 2 City State ZIP Code
Home Phone
Mobile Phone*
Email*
Emergency Contact Name*
First Last
Relation to Musician*
Emergency Contact Home Phone
Emergency Contact Mobile Phone*
Contact Consent*
By checking this box, you give us permission to contact you by email concerning annual registration, rehearsals and performances
Email Marketing Consent
By checking this box, you give us permission to add you to our email marketing list so you receive information about ticket sales and events.
Option 1: Permission to Transport
I give the New Albany Symphony Orchestra and its agents permission to transport me to the below-specified hospital, clinic, doctor’s office or dentist’s office for emergency medical or dental care. I further give my permission to transport me to the nearest source of assistance should transport to the providers below not be reasonably possible.
Hospital
Doctor's Office
Doctor's Office Address
Street Address Address Line 2 City State ZIP Code
Doctor's Office Phone
Dentist's Office
Dentist's Office Address
Street Address Address Line 2 City State ZIP Code
Dentist's Office Phone
Option 2: Refusal to Grant Permission to Transport
I do not give the New Albany Symphony Orchestra and its agents permission to transport me for emergency medical or dental care. In the event of an emergency, I with the New Albany Symphony Orchestra to take the below-specified action.
Emergency Medical or Dental Action
This is a waiver and release of claims. Please read carefully.*
As with all activities, there is some risk of injury, loss or damage at events held by New Albany Symphony Orchestra, Inc. As a condition of your participation, you agree to assume these risks. You also agree to release New Albany Symphony Orchestra, Inc, its officers, employees, trustees, agents and volunteers from any and all claims you might have for any injury, loss or damage. In performance organizations, musicians’ names, area of residence and photos are often released in publicity materials. As a condition of your participation, you consent to the use of such information and photos for publicity purposes. The concerts are recorded for archival purposes and for broadcast. The recordings may be reproduced and sold, at cost, to any musicians performing in the concert for personal listening. As a condition of your participation you agree to such use of the concert recordings. BY SELECTING THIS OPTION, I AGREE TO THE TERMS OF THIS WAIVER AND RELEASE FOR MYSELF OR MY MINOR CHILD.
Our Friends group organizes social and fundraising activities throughout the year. All are welcome to join us! If you are interested, please enter your email address.