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Medical Information

This information is to be retained by Russell Cripps, the MYVoice Program Coordinator, throughout the 2013 season during rehearsals and performances.
All information is treated as confidential and will be made available only to group leaders and, in the case of illness, to medical personnel.

(if the allergy is serious, please indicate approved treatment in the event that the chorister should have a strong reaction while in rehearsal or performance) *

Does the chorister have any health problems that the choir leadership should be aware of? *

MYVoice Youth Choir Parental Consent (singers aged 17 and younger)

Date:

I/we the parent(s) or guardian(s) of name of chorister) do hereby give consent to Chor Leoni/MYVoice representatives and supervisors approved by the Board of Directors, to secure such medical advice and services as may be deemed necessary for the health and safety of the chorister (1) where the health and well being of the chorister is involved, (2) where medical advice has been obtained and normally the consent of the parent or guardian is required, and (3) where all attempts to contact the emergency contact have failed or where due to the nature of the emergency there is insufficient time to contact such emergency contact, it shall be at the discretion of the supervisor as to what steps must be taken for the welfare and safety of the chorister.

I, the parent/guardian of the above-mentioned chorister, do also hereby give consent to Chor Leoni/MYVoice to use my son’s name or image on programs, posters, website, internal site, displays, newspaper/newsletter articles, television/radio broadcasts, CD recordings, videos, and other advertisements or publicity materials. I understand that Chor Leoni/MYVoice will make all reasonable efforts to protect the safety and privacy of my son by never identifying my son by full name in photographs or videos without my specific prior written consent.

I have read this document carefully and understand it.

 Yes  No

By typing your initials in this box, you are acknowledging that you have read and agree to the above terms.

Name of Parent/Guardian: