Child's First Name
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Child's Last Name
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Child's Pronouns
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Please select all that apply.
Honoring identity is part of the mission of the Long Beach Youth Chorus. One way to practice this is to share pronouns with one another.
Child's pronouns were not listed. They are:
Child's Birthdate
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MM
DD
YYYY
Child's Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Which school will the child attend next year?
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Child's Grade for the next School Year
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2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Child's Shirt Size
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Youth S
Youth M
Youth L
Adult S
Adult M
Adult L
Adult XL
Adult XXL
Child's Phone (if applicable)
(###)
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If you are new to our organization, how did you hear about the Long Beach Youth Chorus?
Parent or Guardian #1
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First Name
Last Name
Parent/Guardian #1's Relationship to the Child?
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Parent/Guardian #1 Phone Number
*
(###)
###
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Parent/Guardian #1 Email Address
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Parent or Guardian #2
First Name
Last Name
Parent/Guardian #2's Relationship to the Child?
Parent/Guardian #2 Phone Number
(###)
###
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Parent/Guardian #2 Email Address
Parent or Guardian #2 Pronouns (see above)
Alternate Emergency Contact Name
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Alternate Emergency Phone #
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(###)
###
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Medical Insurance Company
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Insurance Phone Number
*
(###)
###
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Policy or Group Number
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Member ID Number
Child's Physician
Physician's Phone #
(###)
###
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Allergies or Dietary Restrictions
Please mark for any of the over-the-counter medications you wish administered to your child if the need arises:
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STUDENT DISABILITIES AND ACCOMMODATIONS REQUEST
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Reasonable accommodations are determined through an interactive process between LBYC, the student, parents, and instructional staff. Reasonable accommodations should be disability-based, similar to an Individual Educational Plan (IEP) or 504 Plan as found in public schools.
Any adjustments and/or auxiliary aids, and/or modification or adjustment to practices, procedures, or policies are so that a student with a disability receives equal access to rehearsals, programming, services, or activities.
"REASONABLE" ACCOMMODATIONS CAN BE:
1) Changes to a classroom environment or task that permit a student with a disability to participate in the educational process.
2) Reasonable modifications to behavioral and instructional policies, practices, or procedures that enable the student to participate in LBYC's programs—including but not limited to: rehearsals, concerts, lectures, tours, social events, and other necessary resources.
TYPES OF "UNREASONABLE" ACCOMMODATIONS:
1) Accommodations that would fundamentally alter the nature of a program.
2) Accommodations which lower or substantially modify academic, performance, or program standards.
3) Accommodations that would impose undue financial or administrative burden.
4) Accommodations that would pose an appreciable threat to personal or public safety.
SOME EXAMPLES OF ACCOMMODATIONS MAY INCLUDE:
1) Changes to behavioral interventions, consequences, or procedures
2) Notetaking or Visual Aid accommodations such as alternative formats or proximity to the front of the rehearsal space
3) Changes to materials and/or communication strategies for students who are D/deaf, hard-of-hearing, or visually impaired.
4) Specific seating requests to accommodate physical disabilities
5) Inclusion of a service animal in rehearsals and/or activities.
While LBYC is not able to utilize official IEPs or 504 Plans, it is important to our organization that we are aware of any accommodations which may make your child's experience more successful and enjoyable.
Therefore, if you would like to request accommodations, we will follow up with you to collect additional information, but for the time being, please select one of the following options:
If you are NOT requesting specific disability-related accommodations but you would like to share any behavioral or accessibility-related information that may help us to make your child's experience more successful and/or enjoyable, please feel free to share here:
PHOTOGRAPHY & RECORDING RELEASE
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I hereby give permission for my child, who is a member of LBYC, to be photographed and recorded for videos, CDs, and DVDs to be used in in-house displays and LBYC publicity and in media including, but not limited to, newspapers, magazines, brochures, flyers, TV and radio.
PERMISSION AND RELEASE FORM
BY HITTING THE SUBMIT BUTTON BELOW, THE PARENT(S) AGREE TO THE FOLLOWING:
The safety and well-being of your child is of paramount importance to the Long Beach Youth Chorus (“LBYC” or “Chorus”) and the chaperones, employees, administrators, directors, and volunteers of LBYC. All reasonable care and precautions are taken to ensure a safe educational and entertainment experience. The following release is both a requirement of insurance coverage and an important reminder to you as a parent to be sure that your child is properly prepared.
I, the undersigned parent and/or guardian of the child listed in this registration form do state and affirm that I am the legally authorized guardian of the above-named child, and I also give permission for him/her to travel with LBYC to all events scheduled by LBYC, to various locations within the United States or abroad. In consideration of my child being permitted to participate in the above-named events and for other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, I agree as follows:
My son’s/daughter’s participation in LBYC is purely voluntary and I elect to have him/her do so at my own risk. I certify that my son/daughter is in sufficient physical condition to participate in the rehearsal, performance and activities of the Chorus. I also agree to instruct my son/daughter to abide by the rules or instructions given to him/her either verbally or in writing by LBYC. I further understand that LBYC reserves the right, but not the obligation, to refuse to permit any person judged to be physically or mentally unfit to meet the rigors and requirements of participating in any Chorus activity or trip to participate in any or all Chorus-related events.
In the event of illness or accident of/to my child, any employee, volunteer, associate, administrator, director, or chaperone of LBYC, in whose care my child has been entrusted, is authorized to consent to an X-ray, examination, anesthetic, medical, or surgical diagnosis of my child; to the transportation of my child under general or special supervision, and to treatment upon the advice of a licensed physician and/or surgeon. I agree to assume responsibility for all expenses incurred by LBYC in order to obtain medical care for my child. In the event that an authorized representative of LBYC decides that my child must leave an event for medical, behavioral, or other unforeseen reasons, in LBYC’s sole discretion, I agree to assume responsibility for all costs related to his/her return trip home separate from and in addition to any costs already paid. In case of hospitalization or the inability of my child to continue travel with LBYC for any reason, I agree to travel to my child’s location to assume responsibility for care of my child within thirty-six (36) hours of receiving notice.
In return for LBYC allowing my child to participate in the LBYC events and activities, I voluntarily hereby permanently, irrevocably, and forever agree to waive, indemnify, release, discharge and hold harmless LBYC, its directors, employees, associates, agents, and chaperones and St. Matthew Catholic Church, and the parents, related companies, subsidiaries, affiliates, and past, present or future officers, shareholders, agents, representatives, employees, licensees, successors and assigns of the foregoing (collectively, the “Released Parties”) from all causes of action, damages, claims (including, without limitation, claims for personal injury, death, disability, disfigurement, physical or emotional illness, property damage, defamation, false light, copyright infringement, violations of rights of publicity and/or invasion of privacy and/or violation of moral rights), demands, liabilities, costs and expenses of any kind and reasonable attorneys’ fees, known or unknown, which may arise and which the undersigned or said child or any successor may have against the Released Parties’ consent to any medical procedure detailed above, or during a Chorus event or outing, including transportation and lodging, or that may arise out of or in connection with my or my child’s preparation for, participation in or appearance at any LBYC event or activity, whether occurring before, during or after actual participation.
By clicking submit and adding my electronic signature below, I acknowledge that I have read this release, understand all of its terms and their significance, and have executed this release voluntarily. Further, I warrant that the information contained in this document is accurate and that I have the legal authority to agree to the terms of this document and sign below. I understand and acknowledge that this is a legal waiver under applicable law.
ELECTRONIC SIGNATURE OF PARENT/GUARDIAN
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