Queen City youth Choir Registration

Student First Name

Student Last Name

Student Date of Birth

Student School and Grade

Parent First Name

Parent Last Name

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Phone Number

Emergency Contact: Relationship to Student

Parent Email

Parent Phone

Address

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Please tell us if your child has any health issues we should be aware of (i.e. food allergies, asthma, etc.)

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Manchester Community Music School