Fillable Vocal Music Application Chickasaw/Chickasaw family Other tribe/CN employee (The Chickasaw Nation)

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Vocal Music Application Chickasaw/Chickasaw family Other tribe/CN employee (The Chickasaw Nation)

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Page 1 of 3 Form no. 05051VM CH-AH 7/2019
Vocal Music Application
Name:
First Middle Last Suffix
Affiliation: (please select one that best applies to the student)
☐ Chickasaw/Chickasaw family ☐ Other tribe/CN employee ☐ Non-native
Mailing address:
Street/P.O. Box City State ZIP
□ Same as mailing address
Physical address:
Street City State ZIP
Birth date: Age in August 2019: Email:
Please list an email that you check regularly
Phone: ( ) Do you text: □ Yes □ No
Allergies:
Parent information: (please complete this section if the applicant is a minor)
Parent name:
First Middle Last Suffix
Birth date (for security purposes): Phone: ( )
Parent name:
First Middle Last Suffix
Birth date (for security purposes): Phone: ( )
Emergency contact: (Please list two individuals (other than parents/legal guardians) to call in case of an emergency.)
Name: Phone:
Name: Phone:
Photo release:
For parents/legal guardians: By signing this document, I am granting permission for photographs and/or
footage of me/my child to be featured in advertisements and publications for the Chickasaw Nation Dance
Studio.
Parent/legal guardian signature Date
PLEASE COMPLETE ALL THREE PAGES OF THIS APPLICATION
Bill Anoatubby
Governor
Department of Culture and Humanities/Arts and Humanities Division
Performing Arts
Page 2 of 3 Form no. 05051VM CH-AH 7/2019
Class selection: (Please select the class(es) that you or your student are interested in attending.)
□ Training choir (ages 6-7) □ Children’s choir (ages 8-12) □ Youth ensemble (ages 13-18)
□ Vocal development class (reading music, for beginners, ages 13-18) □ Adult choir (ages 19 and up)
Class location and schedule:
Ada area, Mondays
Training choir 4:00 p.m. – 4:30 p.m.
Children’s choir 4:30 p.m. – 5:30 p.m.
Vocal development 5:30 p.m. – 6:00 p.m.
Youth ensemble 6:00 p.m. – 7:00 p.m.
Adult choir 7:00 p.m. – 8:00 p.m.
Tishomingo area, Tuesdays
Training choir 5:00 p.m. – 5:30 p.m.
Children’s choir 5:30 p.m. – 6:30 p.m.
Vocal development/youth ensemble 6:30 p.m. – 7:30 p.m.
Adult choir 7:30 p.m. – 8:30 p.m.
Ardmore area, Thursdays
Training choir 5:00 p.m. – 5:30 p.m.
Children’s choir 5:30 p.m. – 6:30 p.m.
Vocal development/youth ensemble 6:30 p.m. – 7:30 p.m.
Adult choir 7:30 p.m. – 8:30 p.m.
PLEASE COMPLETE ALL THREE PAGES OF THIS APPLICATION
Page 3 of 3 Form no. 05051VM CH-AH 7/2019
COMMITMENT AND CODE OF CONDUCT AGREEMENT
Children’s choir and youth ensemble (performance groups)
The Chickasaw Nation Arts and Humanities Division’s primary goal for the Chickasaw children and youth
choirs is to provide not only a safe environment conducive to learning, but to also make sure that each
student has a memorable experience in representing the Chickasaw Nation as an ambassador.
The choir(s) are invited to many events inside and outside of the Chickasaw Nation boundaries; therefore,
attendance to choir rehearsals and performances is imperative. A choir member’s parent is required to
contact the division office at (580) 272-5520, or phillip.berryhill@chickasaw.net, when he must be absent. If a
choir member is absent for more than two rehearsals, it will then be up to the management and choir
conductor to determine if that choir member may proceed with the program rehearsals or performances.
The use of tobacco, in any form, will not be allowed. Use of foul or abusive language, disruptive behavior,
theft, misuse or abuse of public and/or private property or disrespect of other students or staff members will
not be tolerated. Students demonstrating such acts are subject to being dismissed from the program.
The reason for this agreement is to ensure conduct, behavior, attendance at rehearsals and performances,
so that each student may receive the full benefit of enjoyment and educational experiences this program has
to offer. By signing below, you agree to the terms and conditions of this agreement.
Parent/legal guardian signature (if participant is under the age of 18) Date
PLEASE COMPLETE ALL THREE PAGES OF THIS APPLICATION
Department of Culture and Humanities
Bill Anoatubby
Governor
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Vocal Music Application ChickasawChickasaw family Other tribeCN employee (The Chickasaw Nation)

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Completed 31 January 2021

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