Capri Glee Youth Choir Enrollment











  • Phone Numbers, Email, Emergency Contact

  • Participation Permission

  • By checking the box below, I give permission for my child to participate in the Capri Glee Youth Choir
  • Photo/Video Permission

  • By checking the box below, I give permission for my child I give permission for my child to be photographed and/or videotaped within the context of the 2017 Capri Glee Youth Choir. I also give permission for PCYC to use
    any photograph/video segment for the purposes of advancing the mission of the organization.
  • Clinic/Physician Information

  • Please list two Emergency Contacts











  • Medical Information

  • By checking the box below, I give permission for my child to be seen for health services in the clinic at Plymouth Christian Youth Center and give permission for staff to transport my child to receive emergency medical attention if needed.

 

Verification