Music Ministry for Youth Registration Form

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Registration for 2022-2023 Music Ministry for Youth
The maximum number of form submissions has been reached. This form is currently not available.
- Student Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Singer Voice REQUIRED Please fill out this field.
  
  If you also play an instrument, list it here. Please enter valid data.
  
  Home Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Student Email Address Please enter an email address.
- All communication must include the email address of parents/gardians for those under the age of 18.
- School that you attend REQUIRED Please fill out this field. Please enter valid data.
- Grade for the 2022-2023 year REQUIRED Please fill out this field.
- Parent Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Cell Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Home Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
- Special Concerns? Allergies? Please be specific. REQUIRED Please fill out this field. Please enter valid data.
- Our Music Ministry website will include occasional photos. You can view the release form HERE. Please check "I agree" to grant permission for your child's phote to be used.
- I Agree Please select this field.
Submit

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Contact us:
- Remi Bauer
  
  Director of Music
  
  240-454-5326 or 301-948-7545 X235
  RBauerStRose.com