South Dakota Kids That Rock Registration Form

South Dakota Kids That Rock Registration
Artist Information
Artist's Name

First NameLast Name
Stage Name (If applicable)
Birth Date

MonthDayYear
Grade
Are you performing as a solo, duet, or trio? If performing with other artists, please include their name
Will you be using an instrumental track or a personal accompiantment?

Instrumental trackPersonal accompiantment (Which instrument/Who will be playing?)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name

First NameLast Name
Cell Number
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Does the artist have any allergies, chronic illness, or medical conditions that are pertinent to know? If yes, please describe.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by The Rocke Grace Foundation for Music + Medicine during the selected South Dakota Kids That Rock event.

In case of injury to said child, I hereby waive all claims against The Rocke Grace Foundation for Music + Medicine including all members and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. I consent and acknowlege that my child may be photographed/videotaped during the event and may appear on the offical Rocke Grace Foundation website and associated social medias.
Date

MonthDayYear
Date
Signature

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Registration Fee
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Artist Registration
$25.00

Total

$0.00
Payment Methods

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Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info
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South Dakota Kids That Rock Registration

Artist Information