Which choir group are you signing your child up for? Please SelectPROCLAIM Praise Team (1st-5th Grade)Summer Music Camp (Ages & dates announced annually)Christmas Musical (Ages & dates announced annually) (required)
Child's Name (required)
Gender Please SelectMaleFemale
Does your child play a musical instrument? If so, what kind?
Birthday
Grade (required)
School (required)
Parent/guardian Name (required)
Address (required)
City (required)
State (required)
Zip (required)
Phone (required)
Mobile
Email (required)
Emergency Contact
Emergency Contact Relationship
Emergency Contact Phone (Day)
Emergency Contact Phone (Night)
List Allergies or Medical Conditions
Is ACC authorized to approve medical treatment? Please SelectYesNo (required)
Are you covered by personal/family medical insurance? Please SelectYesNo (required)
If Yes, Name of Insurer
Policy/Group #
Do parents/guardians attend ACC? Please SelectYesNoSometimes THE FOLLOWING PARTICIPATION AGREEMENT IS AN INDEMNITY REQUIREMENT
I acknowledge that participation in the activity described above involves risk to the Participant (and to Participant's parents or guardians, if Participant is a minor), and may result in various types of injury including, but not limited to, the following: sickness, bodily injury, death, emotional injury, personal injury, property damage and financial damage.
In consideration for the opportunity to participate in the activity described above (the “Activity”), the Participant (or parent/guardian if Participant is a minor) acknowledges and accepts the risks of injury associated with participation in and transportation to and from the Activity. The Participant (or parent/guardian) accepts personal financial responsibility for any injury or other loss sustained during the Activity or during transportation to and from the activity, as well as for any medical treatment rendered to the Participant that is authorized by the Sponsor or its agents, employees, volunteers, or any other representatives (collectively referred to hereinafter as the “Activity Sponsor”). Further, the Participant (or parent/guardian) releases and promises to indemnify defend and hold harmless the Activity Sponsor for any injury arising directly or indirectly out of the described Activity or transportation to and from the Activity, whether such injury arises out of the negligence of the Activity Sponsor, the Participant, or otherwise.
If a dispute over this agreement or any claim for damages arises, the Participant (or parent/guardian) and the Activity Sponsor cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution pursuant to the rules of the American Arbitration Association.
The field below represents my digital signature. By typing my full name I agree to the terms and conditions of the participation agreement set forth above. Digital Signature (required)
