RENEGADE OPERA CHILDREN’S CHORUS
(R.O.C.C.)


Childs Name: ________________________________________
Age: _______ Grade:_______ Birthdate: _____/_____/_________

Parents Name(s)_________________________________
Home Address____________________________________
Email Address(es): ________________________________
Home Phone: ___________________
Parent Cell phone(s):_______________________________
Best number to contact you______________________

Other Emergency Contact Name/Phone:___________________________________

Name of School: ________________________________

Music Teacher: ___________________________

Instrument(s) played________________ For how long?_________

Does your child have any previous choral experience? (It is not required) If yes, please specify. ______________________________________________________________

May we include your child in images used on our web site, brochure and possible media coverage? Your child would not be identified by name.
___Yes ___No


Signature:___________________________________________
Date _____/_____/________


Please attach check made payable to R.O.C.C. director Mark Power.
Tuition is $495 for the season or $175 for each of the 3 terms.

Mailing Address:
R.O.C.C. / Mark Power
1507 Queen Anne Avenue North
Seattle, WA 98116

Questions? Contact:

Elizabeth Power
power4art@yahoo.com
206.217.0425

Nancy Horner
Nancy@nancyhorner.net.
425.226.0240