Summer Workshop Registration - The Voice Co-op

Participant Information

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Birthdate *

School and Grade Level Fall 2017 *

List songs that participant will bring for coaching. These must be memorized. Only one song is needed, but you may list as many as you like so that we have options from which to choose. *

Parent/Guardian Information

Name *

First

Last

Email *

Phone Number *

I give permission for Rebecca Flaherty to transport my child in her vehicle during the week for trips to special presentations, meals each day, and for a trip to Tybee Island on Friday, July 21.

Electronic Signature of Parent/Guardian *

Emergency Contact Information

Name *

First

Last

Phone Number *

Preferred Hospital *

Insurance Provider *

Policy Number *

Submit