Application Form

(An * indicates required fields.)

Student Information:
* First Name:
* Last Name:
* Street address:
* City:
* State:  * Zip Code: 
* Home Phone: 
* Age:   * Date of Birth: (mm/dd/yy) 
* Current Grade in School: 
* Student Cell Phone:
* Student Email:
* Best Way to Contact Student:
* Home Church:
* Singing Experience:
* Select your singing part:   
* Musical Instruments I Play:
* Musical Instrument Proficiencies:
* Describe Your Involvement on The District:
* Why do you want to be in the Impact Choir?
* T-Shirt Size:
Answer the following questions to tell us about your relationship with Christ. Take this portion of the application seriously! This is probably the most important part!
* Explain how your relationship with Christ began.
* Explain how and why it has grown.
* Tell how God is using you to make a difference in the world around you.
* How do you think God can use you to further accomplish His will?
Parent Information:
* Father's Name:
* Father's Phone:
* Father's Email:
* Mother's Name:
* Mother's Phone:
* Mother's Email:
Other Information:
* Pastor's Name:
* Pastor's Phone:
* Pastor's Email:
* Youth Leader's Name:
* Youth Leader's Phone:
* Youth Leader's Email:
* Music Leader's Name:
* Music Leader's Phone:
* Music Leader's Email:

Emergency Information:

* List All Allergies, Food Sensitivities, and Other Medical Conditions:
* In Case of Emergency Contact:
* Phone: 
* Relationship to Student:
Notes: Use this area to note any other important information.
IMPORTANT NOTICE:
- Make sure you complete this entire registration form. Don't leave any items blank, enter 'none' if there is no information for that item.  
- Send your $25 application fee to:
    Impact Choir
    c/o Eddie Laub
    5606 E. 28th St.
    Tucson, AZ 8511
    Make checks payable to AZNYI

- By clicking 'Submit,' I acknowledge that I have read the entire Application page and this form is filled out truthfully. I understand that if information is left blank or inaccurate, it may affect my application process.