Choir Registration

Smoot Theatre Youth Ensembles enrollment form

* Indicates required field

Student's Name *

First

Last

Student's Gender *

Date of Birth *

Address *

City *

State *

Zip *

Student's Personal Phone *

Student's Personal Email *

School attending now *

School attending this fall *

Grade this fall *

1st Parent/Guardian's Name *

Mobile Phone *

2nd Phone *

Email *

2nd Parent/Guardian's Name *

Mobile Phone *

2nd Phone *

Email *

List all extracurricular activities *

List any instruments you play *

I sing in a school choir *

Yes No

I sing in a church choir *

Yes No

I sang in a previous Smoot Spring Sing *

Yes No

Doctor's Name *

Doctor's Phone *

Medical conditions/allergies we should know about *

Emergency Contact Information
In an emergency, I understand you will take whatever measures are necessary to handle the medical situation.
If neither of the parent/guardians listed above can be reached, please notify:

Contact's Name *

Contact's Phone *

Relationship to student *

I am enrolling for *

Submit Enrollment

Ensembles Enrollment

Smoot Theatre Youth Ensembles enrollment form

304.422.7529

213 FiFth Street, Parkersburg, WV