Registration: Youth Music Registration

First Name:
Last Name:
Phone (515-XXX-XXXX):
Confirm Email:
Date of Birth:
Male  Female  
Are there any custodial issues of which we should be aware?:
List any allergies or medical conditions:
List a non-parent emergency contact (name, relationship, number):
Mom/Guardian Contact (name, email, cell phone):
Dad/Guardian Contact (name, email, cell phone):
Select your 2017-2018 grade:
6th  7th  8th  9th  10th  11th  12th  
I wish to receive text messages to the following phone number(s)::
I would like to be in the following church-wide Worship Arts groups (select all that apply)::
CLC Praise Choir (6th & up) Mondays, 6:30-7:10pm, CLC Music Room
Heavenly Metal Handbells (6th-12th) Wednesdays 4:50-5:20pm, Uptown Bell Room
Instruments of Peace Orchestra (10th & up) Wednesdays 7:00-8:00pm, Uptown Chapel
Chancel Choir (10th & up) Wednesdays 7:00-8:15pm, Uptown Choir Room
Men's Vocal Group (10th & up) Thursdays 7:00-8:00pm, Uptown Choir Room
I would like to participate in Illumin8 Youth Worship Arts groups, which include Worship Teams for Spark & Ignite Youth groups, and occasional presentations in worship.:
Illumin8 VocalIllumin8 Instrumental
I am able to play the following instrument.:
Choose the rehearsal time that works best:
Wednesdays 5:25-6:10pm, Uptown Music Room (transportation provided from Uptown to the CLC for Spark Youth Group)  
Sundays 6:30-7:15pm, CLC Music Room  
I give permission for this minor's image/recording to be used in Ankeny First United Methodist Church's publicity, both internal and public. Please note that no names will be associated with any image or recording.
Type your name in this box that you agree to the above :
Ankeny First United Methodist Church
206 SW Walnut Ankeny, Iowa 50023