Parent/Guardian Name *
Parent/Guardian E-mail *
Parent/Guardian Phone *
Please list your primary phone number where you can be reached during the day.
Parent/Guardian Alternate Phone Student Name *
Student's Home Address
* Student Birthdate *
Student Grade in Fall 2018 * 3rd 4th 5th 6th Student Gender * Male Female Student T-Shirt Size * Youth Medium Youth Large Adult Small Adult Medium Adult Large Student School * Music Teacher
School music teacher, or if your child takes private lessons on an instrument or voice.
Student Ethnicity (optional - for grant purposes)
To select multiple options, hold down the Ctrl key while making selections.
African American Asian American Caucasian Hispanic/Latino Other Student Health and Safety *
Please indicate any allergies, medical conditions, or medications (epi-pens) that may affect your child's participation in Summer Camp. Enter NONE if there are no health or safety concerns for your child.
Emergency Contact Name *
Emergency Contact's relationship to Student *
Please indicate if this is a Parent, Grandparent, Friend of Family, etc.
Emergency Contact's Phone Number *
Please list the primary daytime phone number.
Emergency Contact's Alternate Phone Number Preferred Hospital *
FOR MEDICAL EMERGENCIES ONLY - I authorize The St. Louis Children's Choirs to transport my child to the hospital(s) selected. (To select more than one option, hold down the Ctrl key while clicking.)
Nearest/No preference Missouri Baptist Mercy/St. John's St. Louis Children's Hospital Cardinal Glennon Barnes Jewish St. Luke's St. Clare's St. Mary's Do Not take to hospital, contact parents How did you hear about The St. Louis Children's Choirs Summer Camp? * Special Notes/Comments
Please use this space for any unusual situations which camp staff should know about, including if anyone other than a parent is authorized to pick-up your child at the end of the camp day. *Note- please include a phone number for the authorized person and a note of which day(s) they may be picking up.
Medical Release * Photo Release * Terms and Conditions *
This field is for validation purposes and should be left unchanged.