MAIL THIS FORM WITH YOUR REGISTRATION FEES

NCMEA ELEMENTARY HONORS CHORUS

Student Registration and Emergency Contact Form
Teacher: Please have each accepted student complete a copy of this form. Make a copy to retain for your records,
and submit the original to Jana Winders, the Honors Chorus Chair, with your School Registration Form, and a
school check or money order.
Student Name: ________________________________________________________________
Registration fee is $35.00 per person
Student T-shirts are included in the registration fee. Sizes are Adult only S-XXL. Teachers may purchase a T-shirt
for $10 each. CDs and DVDs will be made of the performance and are available for pre-order from White Sound
Studios webpage. Recordings will include all three honor choruses-elementary, middle, and high schools.
Registration @

$35.00

___________

T-shirt

(Size____________)

Cost included

CDs@

$20.00

___________

DVDs@

$25.00

___________

Total Included
___________
EMERGENCY INFORMATION
I authorize _____________________________ (music teachers name) to grant consent for medical treatment in
an emergency for my child in my absence on November 10th &11th, 2012. I assume all financial responsibility for
medical costs over and above my insurance benefits.

Students Name:_____________________________________________________________________
Parent/Guardians Name (print): ________________________________________________________
(signature):__________________________________

Date:________________

Relationship to child:_________________________________________________________________
Phone:__________________________________

Cell Phone:_______________________________

Emergency Contact Name:_____________________________________________________________

Phone:__________________________________

Cell Phone: _______________________________

Insurance Company: _________________________________________________________________

Policy Holder: ______________________________________________________________________
Policy Number: __________________________

Group Number: ____________________________

PHOTOGRAPHING AND VIDEOING STUDENTS AT NCMEA STUDENT EVENTS

NCMEA will take photographs during the conference for archival and publicity purposes. These pictures and videos
may be used on the website, conference recordings, newsletters, and other NCMEA printed materials.
I, _____________________________ (parents names) give permission to the NCMEA or the news media to make
or use photographs, slides, videos, recordings, or illustrations of my child, ______________________________.
Signature ____________________________________________

Date __________________

Please complete all information and return it to your teacher with a check or money order made out to
________________________(school or teacher)
All registrations must be submitted to NCEHC
by October 9th.