SHOUT! Arts

______________________________________________                      _____________________________
Participant First Name                                                                                          Last Name

_____  ____________     ____            _________________________________________
Gender    Birth date     Grade (2008-09)                                 School (2008-09)

_______________________________________________________________________
Mailing Address                                                                               City                     Zip


The participant lives with:       __ both parents __ mother __ father __ other guardian

Mother’s Name____________________________________________________
Home Phone_______________ Work Phone______________ Cell Phone_____________
E-Mail ___________________________________        Do you check it daily? __yes __ no

Father’s Name_____________________________________________________
Home Phone_______________ Work Phone______________ Cell Phone_____________
E-Mail ___________________________________        Do you check it daily? __yes __ no

Non-custodial Parent_______________________________________________
Home Phone_______________ Work Phone______________ Cell Phone_____________
E-Mail ___________________________________        Do you check it daily? __yes __ no

Emergency Contact Person _________________________________________
Home Phone_______________ Work Phone______________ Cell Phone_____________
E-Mail ___________________________________        Do you check it daily? __yes __ no


The above mentioned youth participant has received music instruction in:
__choir      __band    __voice training     __drama    __individual musical instrument lessons __other       (please list)

 

 

 

I, the undersigned participant or parent/legal guardian of the above-named participant, give my permission for the above-named to participate in all activities of SHOUT! Arts the Los Banos Grassroots Community Arts Group.

I further give my approval for the above-named to be documented by audio, video, and still photography during the SHOUT performances for publicity and documentary purposes. I understand that his/her image may also be used on the website for these purposes. I waive all rights to wages or royalties that might otherwise be expected as a result of the creation and use of these recordings and images for those purposes.

I also give permission for my child to complete surveys and evaluations that will be used to determine program effectiveness or to promote the program.

I understand that the quality of the above-named participant’s experience in SHOUT depends on my family’s cooperation and involvement.  As such, I or a designated guardian will try to attend a majority of the practices.



____________________________       ____________________________
Participant (Please Print Name)                            Signature of Participant

____________________________       ____________________________
Parent/Legal Guardian (Please Print Name)           Signature of Parent/Guardian

____________________________       ____________________________
Parent/Legal Guardian (Please Print Name)           Signature of Parent/Guardian

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As a participant in SHOUT events, you have the responsibility of representing SHOUT programs to the public.  You are expected to conduct yourself in a manner that will bring honor to you, your family and SHOUT. To do that, you must:

o    Attend all rehearsals and participate in all performances. If you are unable to attend or participate, please inform the workshop director immediately.

o    Follow hours and room rules established before the event begins. Remain in the assigned program areas (i.e. rehearsal room, performance building) during practices and performances.

o    Dress appropriately for each event based upon the workshop director’s attire guidelines.

o    Know and use language and manners appropriate for SHOUT.  Think before you act.

o    Model respect for other persons, facilities and property. Help other SHOUT members to have a blessed experience by making every attempt to include all participants in activities.
 

MEMBER: I have read the SHOUT Code of Conduct above and agree to live up to the expectations. I realize my failure to do so will result in a loss of privileges during the event and/or in the future.

Member Signature_______________________________________________
Date _________________
 

GUARDIAN: I have read the SHOUT Code of Conduct above and agree that my child’s failure to live up to these expectations should result in a loss of privileges during the event and/or in the future.

Guardian Signature_______________________________________________
Date _________________