Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Cell phone *

(###)

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Home phone

(###)

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Voice Part *

Soprano

Alto

Tenor

Bass

Other

Not Sure

Date of birth *

MM

DD

YYYY

Gender *

Female

Male

Non-binary

Other

Prefer not to say

How did you learn about the program? *

Attended the program previously

Family/friends/word of mouth (please list name below)

Teacher (please list name below)

Community choral ensemble (please list name below)

Internet Search

Other

First Emergency Contact Name *

First Name

Last Name

First Emergency Contact Phone Number *

(###)

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Second Emergency Contact Name *

First Name

Last Name

Second Emergency Contact Phone Number *

(###)

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Private teacher name

First Name

Last Name

I have been vaccinated against COVID-19 *

Please note that to participate in SING! Adult you must be fully vaccinated against COVID-19, this means having received at least 2 doses of the Pfizer or Moderna vaccine or 1 dose of the Johnson & Johnson vaccine.

Yes

No

Health Care Provider Telephone *

(###)

###

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Health Insurance Provider Telephone *

(###)

###

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Please confirm the following: *

This information will be kept by the Program Director, who may share the information as necessary with health care providers or insurance carriers. The information is required for attendance in the Sing This Summer programs in order that the participant may be provided with emergency medical coverage for accidents or illness during the course of the program. I understand that I have been selected to attend a summer program run by Sing This Summer, Inc., to be held June 23-26 2022, on the campus of Cabrini University in Radnor, Pennsylvania. I do hereby request that Sing This Summer take whatever steps necessary to secure medical treatment of me in the event that I appear to be in need of such treatment while attending the Sing This Summer program. I consent to the rendering of all necessary treatment, including admission to a hospital or another appropriate health facility, in such institutions and at such places as Sing This Summer, acting through its agents, deems best. I authorize the agents or employees of Sing This Summer to execute whatever forms might be necessary to ensure complete and adequate care of me. If medical treatment is necessary, I hereby authorize any physician or trainer selected by Sing This Summer personnel to order and conduct medical procedures for me (above-named participant) as necessary. I have indicated all health concerns or medical conditions that could adversely impact or limit my participation in the program (e.g., asthma) or emergency treatment below, including drug, food or environmental allergies, (e.g., bee stings). By checking this box I confirm that I have read and agree to the above. I understand that this form is being submitted electronically and that my typed name below shall constitute my signature on this registration form.

Yes, I confirm

Select one package *

Package A (overnight) includes housing, all meals, and evening offerings. Package B (days & evenings) includes all meals and evening offerings. Departure is at 9:00pm. Package C (days only) includes lunch. Departure is at 5:45pm.

Package A (overnight): $725

Package B (days & evenings): $550

Package C (days only): $495

Add-On Classes *

Daily private voice lessons: $175

Chamber Group (coachings and performance of a one on a part piece): $100

I do not want any add-on classes

Method of payment *

Check

Credit Card

Photo/Video Consent *

Do you give permission for Sing This Summer, Inc. to use your photograph, video and audio recordings, likeness, and comments in publications, web pages and other promotional materials produced, used by and representing Sing This Summer, Inc. for the purpose of promoting the program? The circulation of the materials could be worldwide and there will be no compensation for this use.

Yes

No

Please confirm the following *

Applications are accepted on a first-come, first-serve basis. A $100 non-refundable deposit is required with initial registration in order to hold a space in the program. The student is fully registered upon receipt of completed registration packet and balance of fees, which must be received by May 1, 2022. After May 1, partial refunds may only be possible depending on the policies of the host institution. I understand all SING! participants are required to comply with program and college rules and regulations and any federal, state, and local law. Violations or misconduct will result in immediate dismissal from camp without refund. The program does not discriminate on the basis of sex, race, color, national or ethnic origin, religion or physical handicap. I understand that after June 1, no refunds or deductions for the cost of the program will be made for any reason including cancellation, late arrival, early departure, sickness or expulsion for disciplinary reasons as explained by the rules distributed upon arrival by Sing This Summer, Inc., Cabrini University, federal, state and local law. By checking this box I confirm that I have read and agree to the above "Terms and Conditions for Enrollment". I understand that this form is being submitted electronically and that my typed name below shall constitute my signature on this registration form. My signature and submission of this form indicate that I agree to the "Terms and Conditions for Enrollment".

Yes, I confirm

Date of submission *

MM

DD

YYYY