Participant (Student) Information

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Student Cell Number *

Preferred Student Email Address *

Grade *

School: *

Have you participated in an SJR Chorus before? *

Yes

No

Parent/Guardian Information

Relationship to Student: *

Parent(s)

Guardian

Other Other

Parent/Guardian #1 First Name *

Parent/Guardian #1 Last Name *

Parent/Guardian #2 First Name

Parent/Guardian #2 Last Name

Street Address (if different than above)

Address Line 2 (if different than above)

City (if different than above)

State (if different than above)

Zip Code (if different than above)

Parent/Guardian Cell Phone Number *

Home Phone Number

Parent/Guardian Email Address *

How or from whom did you learn about our program? *