Euphorium Youth Academy Enrolment Form

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Please note this form will have to be filled out once for each child.

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Program *

Student Full Name *

Age *

School Grade *

Medical/special requirements

Parent/Guardian Contact (Full Name) *

Phone Number *

Email *

Media release *

I give permission for my child to be photographed and/or filmed and I grant Euphorium Creative full rights to use the images resulting from the photography/video filming, and any reproductions or adaptations of the images for fundraising, publicity or other purposes to help achieve the group’s aims.

Yes

Required

Transportation *

I give permission for Euphorium staff to provide transportation for my child if necessary after confirming with an approved parent/guardian.

Submit

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