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Registration Form
*
Indicates required field
In which session would you like to enroll your child?
*
Session 1 - 9:00 am - Noon
Session 2 - 1:00 - 4:00 pm
All campers receive a camp t-shirt. Please select your child's t-shirt size.
*
Youth Medium
Youth Large
Youth Extra Large
Adult Small
Adult Medium
Adult Large
Adult Extra Large
Child's First Name
*
Child's Last Name
*
Child's Grade (Fall of 2017)
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4th
5th
6th
7th
8th
Guardian #1 Name
*
Guardian #2 Name
*
Guardian #1 Home Phone
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Guardian #1 Cell Phone
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Guardian #2 Home Phone
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Guardian #2 Cell Phone
*
E-mail (camp correspondence is through e-mail)
*
Mailing Address
*
City
*
Zip Code
*
Please indicate your child's school district
*
Allen ISD
Arlington ISD
Carrollton-Farmers Branch ISD
Dallas ISD
Frisco ISD
Grapevine-Colleyville ISD
Grand Prairie ISD
Home School
Lewisville ISD
Irving ISD
Mansfield ISD
McKinney ISD
Mesquite ISD
Plano ISD
Richardson ISD
Rockwall ISD
Wylie ISD
Not on list
If your child's school district was not included on the list above, please list it below.
*
Health Form
Child Date of Birth
*
Child Age
*
Emergency contact to call if unable to reach guardian
*
Relation to child
*
Emergency Contact Home Phone
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Emergency Contact Work Phone
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Emergency Contact Cell Phone
*
Child's Physician
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Physician Phone
*
Date of last physical
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Date of last Tetanus or Booster shot
*
Is child covered by a Health Insurance Policy?
*
Yes
No
Insurance Company
*
Policy #
*
If child requires hospitalization, where would you prefer they be taken?
*
Health History (check all that apply)
*
Ear Infections
Rheumatic Fever
Convulsions
Epilepsy
Heart Condition
Diabetes
Fainting Spells
Motion Sickness
Wears Glasses/Contacts
Allergies (check all that apply)
*
Hay Fever
Asthma
Insect Stings
Dogs/Cats
Foods (specify below)
Penicillin
Other drugs (specify below)
Other (specify below)
Diseases (check all that apply)
*
Measles
German Measles
Mumps
Chicken Pox
Other (specify below)
If you checked "other" above, please specify below
*
List medications currently being taken on a regular basis
*
Describe any learning problems or disabilities
*
Describe any recent serious illnesses or operations
*
In Case of an Emergency, I give my permission to adult persons representing the Children's Chorus of Greater Dallas to obtain and agree to emergency medical treatment for my child, to hospitalize him/her if necessary, and to agree to surgical treatment to save my child's life, if, after diligent effort, a parent/legal guardian of the child cannot be located and medical exigencies require that a decision be made. It is understood that every effort will be made to reach the persons named on this form.
Type your full name to agree to the statement above.
*
Date
*
We are able to offer this camp free of charge due to generous grant funding. Providing the requested information below is optional and is collected for grant proposal purposes.
Child's Ethnicity
*
American Indian or Alaskan Native
Asian or Pacific Islander
Black, non-Hispanic
Hispanic
Multi-Racial
White, non-Hispanic
Household Income
*
Under $15,000
$15,000 - $24,999
$25,000 - $34,999
$35,000 - $49,999
$50,000 - $74,999
$75,000 - $99,999
$100,000+
Submit
Home
Programs
Choruses
Auditions
Support
Individual Giving
Corporate Giving
Rosemary Heffley
About
About CCGD
News
>
DSO
Kim Noltemy
Obelisk Awards
TACA New Works
Contact Us
Alumni
Donate
