Una Baptist Church
Wednesday, November 14, 2018
Music & Arts Academy Registration

Monday, June 25th through Friday, June 29th

 
All fields below are required unless indicated. Please note that we require the name, cell phone and email address of at least one local Parent or Guardian plus another Parent or trusted Adult. 
 
Remember that this week is available for 4 year-olds through rising 6th Graders. 
You will need to complete an additional Registration form for each attending child.
 
 
Child's First Name:  
Child's Last Name:   
 
Gender:      Male        or        Female
 
Child's Address:
 
Please identify all known Allergies this child has:
 
Child's Date Of Birth (mm/dd/year):  
 
What T-shirt size do you want for your child?
   Adult size
   Child size

   Extra small
   Small
   Medium
   Large
   Extra Large
 
Child's Age or Grade in School in Fall 2018*:  
      4 year-old*
      5 year-old*
      1st Grade
      2nd Grade
      3rd Grade
      4th Grade
      5th Grade
      6th Grade
 
* All 4 and 5 year-olds will experience the Music and Arts Academy in a fun way that is tailored to their ages. No need to complete the Top 3 choices if your child is 4 or 5 years old. 
 
 
What is this child's TOP 3 Choices for the Specialized Class time?
 
First Choice?  (pick 1) 
  Dance Fusion  
  Video Production   
  Percussion   
  Music FUNdamentals    
  Art - Batik Painting   
  Art - Drawing   
  Step Dance
 
Second Choice?  (pick 1) 
  Dance Fusion  
  Video Production   
  Percussion   
  Music FUNdamentals 
  Art - Batik Painting   
  Art - Drawing   
  Step Dance
 
Third Choice? (pick 1) 
  Dance Fusion  
  Video Production   
  Percussion  
  Music FUNdamentals   
  Art - Batik Painting   
  Art - Drawing   
  Step Dance
 
 
Parent/Guardian's First Name:  
Parent/Guardian's Last Name:  
Parent/Guardian's Address (if different):       
 
Parent/Guardian's Cell Phone with area code:  
Parent/Guardian's Home Phone (optional):   
Parent/Guardian's Email Address:  
 
Parent 2 or Trusted Adult's First Name:  
Parent 2/Adult's Last Name:   
Parent 2/Adult's Cell Phone with area code:   
 
 
Check your answers and press  
 
If you have any questions, please call our office at (615) 361-5775.