PACC Youth Chorus Registration Form - Peoria Area Civic Chorale

Name of School(Required)

Home Phone(Required)

Preferred contact e-mail(Required)

Preferred contact phone number(Required)

Other contact e-mail

Guardian's Name(Required)

Guardian's address (if different from child)

Guardian's Cell Phone

Allergies(Required)

Does your child have any food or medication allergies that the staff should be aware of?

Medical Information

Does your child have a medical condition that the staff should be aware of? (Ex: ADHD, Diabetes etc.)

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