A.B.C. Play Registration

Emergency Information

We collect medical information for all in-person and virtual services. This information will be used if we need to contact emergency services while the participant is with us.
Please list any allergies. Write "N/A" if none.*
Does the student have an epi-pen?*

YesNo
Emergency Contact Name*

First NameLast Name
Emergency Contact Relation to Student*
Emergency Contact Phone*
Please enter a valid phone number.
Second Emergency Contact Name (Optional)

First NameLast Name
Second Emergency Contact Relation to Student (Optional)
Second Emergency Contact Phone (Optional)
Please enter a valid phone number.
Medical Attention

In the event of a medical emergency, Sing Explore Create, LLC will make every effort to contact the parent/guardian and emergency contact listed below. If neither can be reached, Sing Explore Create, LLC reserves the right to call emergency personnel to transport the participant to the nearest medical facility for necessary medical treatment.
I have read and agree to the above statement regarding medical attention.
Pick-Up Policy: To ensure the safety of students under 18, we may request photo ID from individuals picking them up from ABC Play. Only those authorized by the parent or guardian will be allowed to pick up students. Please provide the names of authorized persons below. If someone not listed needs to pick up a student, written permission from the parent or guardian must be given to ABC Play staff in advance.*

Media Permissions

At times we may take pictures, videos, and audio recordings during classes/sessions. We utilize recorded media for marketing and professional development purposes. For marketing, recorded media may be shared to our website, professional Facebook page, and used to produce other marketing materials (brochures, newspaper articles, etc). For professional development, recorded media is viewed by staff members at Sing Explore Create for educational purposes. Please indicate your preferences below:
Please indicate your preference below:*

Yes - I give permission for Sing Explore Create, LLC and Leading Therapy Home to take pictures, videos, and audio recordings of the student.No - I do not give permission for any pictures, videos, or audio recordings of the student to be taken.
PROMO CODE (if applicable):
Would you like to subscribe to the Sing Explore Create newsletter?

Yes, subscribe me to this newsletter.
HOW DID YOU HEAR ABOUT US?

Social MediaGoogle SearchRecommended by a friend/family memberMet us at an eventReferred by a Community Resource (school, healthcare provider, library, etc.)Other
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A.B.C Play! Registration Form