Westbury Kids Music & Arts Troupe Registration

How many children will attend?	One Child  (Add $25.00)Two Children  (Add $50.00)Three Children  (Add $75.00)Four Children  (Add $100.00)
Child #1 - Name
Child #1 - Grade	Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade
Child #2 - Name
Child #2 - Grade	Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade
Child #3 - Name
Child #3 - Grade	Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade
Child #4 - Name
Child #4 - Grade	Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade
Name of Parent/Guardian	*
Your Street Address	*
City, State, ZIP	*
Your Preferred Phone	*
Your Email Address	*
Additional Emergency Contact (must be different from parent/guardian)	*
Preferred Phone of Emergency Contact	*
Do your children have any food or environmental allergies? Please list here or type "none."  *
Do you have a home church or other place of worship? If so, what is the name of that place of worship?
Is there anything you want us to know about your child?
Photo Release: Do we have permission to take and use photographs of your child(ren) in print and online for promotional purposes?	*  YesNo
Are you available to support Arts Troupe by donating snack supplies or serving as an extra helper?
Total	$