Children's Choir Registration

Child's First Name REQUIRED Please fill out this field. Please enter valid data.

Child's Middle Name Please enter valid data.

Child's Last Name REQUIRED Please fill out this field. Please enter valid data.

School grade REQUIRED Please fill out this field. Please enter valid data.

School REQUIRED Please fill out this field. Please enter valid data.

Birthdate REQUIRED Please fill out this field. Please enter valid data.

Parent Name(s) REQUIRED Please fill out this field. Please enter valid data.

Address REQUIRED Please fill out this field. Please enter valid data.

Family primary e-mail Please enter valid data.

Family Secondary Email Please enter valid data.

Family Primary Phone Number REQUIRED

This is the number you would like to be contacted at first. If this is a cell phone, please indicate whose number it is.

Please fill out this field. Please enter valid data.

Family Primary Phone Type REQUIRED Home Phone Cell Phone Please fill out this field.

If cell phone, whose? Please enter valid data.

Primary Cell Phone Texting Yes! Please send text messages. No! Please do not send text messages.

Family Secondary Phone Number

If this is a cell phone, please indicate whose number it is.

Please enter valid data.

Family Secondary Phone Type Home Phone Cell Phone

Family Secondary Cell Phone Owner Please enter valid data.

Secondary Cell Phone Texting Yes! Please send text messages. No! Please do not send text messages.

Does your child have food allergies? REQUIRED Yes No Please fill out this field.

Food Allergies

Health/Medical Conditions

After choir, my child will be... REQUIRED Picked up Returning at daycare at St. Edward School Please fill out this field.

Student Photography Release REQUIRED

Occasionally, photos of the choir (group and/or individual) are taken and posted on websites or in the media. I understand that by responding 'yes' and submitting this form, I hereby grant authority to my child's school/church for the use of any videotapes, photographs, or similar items to be used by the media and/or on a school/church website, Facebook page, or other publications.

Yes, my child's picture MAY be taken and posted as outlined in the instructions included. No names will be published with the photograph(s). No, my child's picture MAY NOT be taken and posted as outlined in the instructions included. Please fill out this field.

St. Edward Catholic Church

1423 Kimball Avenue, Waterloo, IA 50702 319-233-8060

The Mission of St. Edward Church is to be
an evangelizing community
by faith, with love, in hope.

Children's Choir Registration