Student Registration form

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

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

Gender REQUIRED Please fill out this field.

Birthday REQUIRED Please fill out this field. Please enter a date.

Height for Grades 5-8 (Feet & Inches) Please enter valid data.

School Attending Fall 2022 REQUIRED Please fill out this field. Please enter valid data.

Grade in Fall 2022 REQUIRED Please fill out this field.

Does the student have previous choir experience? REQUIRED Yes No Please fill out this field.

If Yes, where? Please enter valid data.

Does the student play an instrument? Yes No

If Yes... what instrument, and how many years? Please enter valid data.

Is the student interested in taking private music lessons through the St. Rita Choral Academy? REQUIRED Yes - piano Yes - voice No Please fill out this field.

Is the student interested in Music Theory/History class? REQUIRED Yes No Please fill out this field.

After rehearsal, student will be: REQUIRED Dismissed to St. Rita Extended Day Picked up Please fill out this field.

If the student is being picked up, please list the names and phone numbers of those allowed to pick up your child. Please enter valid data.

Allergies (Medicine, Food, etc) Please enter valid data.

Special Needs/Medication Please enter valid data.

Authorization of Consent to Treat Minor:
I am the Parent/ Guardian/Conservator and as such do hereby authorize St. Rita Catholic Community, its leaders, employees, contractors and volunteers as agent(s) for the undersigned to consent to any x-ray examination, anesthetic, medical, dental or surgical diagnosis or treatment, and hospital care which is deemed advisable by, and is to be rendered under the general or specific supervision of any physician or surgeon licensed under the laws of the jurisdiction where such diagnosis or treatment may be given, whether such diagnosis or treatment is rendered at the office of said physician, at a hospital, or at any other location. In consideration of acceptance of this authorization, but without any time limitation and without any future right of revocation, I hereby release, defend and hold harmless the Parish and the Diocese of Dallas, their offices, directors, employees, youth ministry leaders, volunteers, and contractors from all claims, liabilities and loss in any way arising out of or in connection with or relating to such treatment and treatment decisions.

Authorization of Consent to Treat Minor REQUIRED Yes No Please fill out this field.

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

Doctor's Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Health Insurance Company REQUIRED Please fill out this field. Please enter valid data.

Policy Number REQUIRED Please fill out this field. Please enter valid data.

Insurance Company Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Media Consent:
I hereby grant permission to St. Rita Catholic Community to allow my above-named child to be photographed and/or interviewed. It is my understanding that these photographs and/or interviews or portions thereof will be used for public view. I agree to participate in this project without financial remuneration, and I understand that this releases St. Rita Catholic Community and the Diocese of Dallas from any future claims as well as from any liability arising from the use of said photographs and/or interviews.

Media Consent REQUIRED Yes, I give my consent No, I do NOT give my consent Please fill out this field.

We agree to read and sign the Student/Parent Agreement. Please bring the Student/Parent Agreement form to the first day of rehearsal. You can download the agreement on the left side of this webpage. REQUIRED Agree Please fill out this field.