Web Site Child's Name * Grade School Experience playing any instrument Experience reading music Instrument choice Date of Birth * Care Card # * Program Name If your child has and medical or other conditions that affect you child's participation in any program provided by the Dawson Creek Kiwanis Community Band, please contact staff immediately so that the appropriate arrangements can be made. Consents I Consent to my child's participation in the above program. I acknowledge that it is my responsibility to advise the Dawson Creek Kiwanis Community Band of any medical conditions that may affect my child's participation in the above program. In the event that my child requireds medical attention, I consent to my child being transported to the nearest emergency centre, including ambulance if necessary, and accept that I am responsible for any costs of such ambulance service. Do you agree for the Dawson Creek Kiwanis Community Band to take and use photographs of the above mentioned child for promotions and records? * Yes No I have read this Parental Consent Form, understand and accept its terms. I have read this Parental Consent Form, understand and accept its terms. * Emergency contact details Parent/Guardian Name Home Phone Cell Phone Work Phone Parent/Guardian Name Home Phone Cell Phone Work Phone Alternate Emergency Contact Name Home Phone Cell Phone Work Phone Are there any other important details that you would like us to be aware of? (Example allergies)