D10 Chorus Student Form

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Student Information		Student Medical Form		Special Dietary Needs		Thank You

Student Name
N/A

Required First Required Last
Full School Name *
N/A

i.e. Henderson HS, Fox Chapel Area HS, Cochranton JSHS; Do not abbreviate the base school name, HS & JSHS is acceptable
Director Name
N/A

Required First Required Last
Director Cell Phone Number *
N/A

### ### ####
Director Primary Email *
N/A
Confirm Your PMEA District:
N/A
Gender *
N/A

Female
Male

Select the gender with which you most identify. For special accommodations, it is the director's responsibility to notify the PMEA District President and Festival Host.
Age *
N/A
Grade *
N/A
Part *
N/A
Height in Inches *
N/A

Must use all numbers in the field i.e. 62, 73, 60.5, 61.75
Student Primary Email
N/A

*Non-school email address preferred due to school firewalls
Student Cell Number
N/A

### ### ####
Student Home Address
N/A

Required Address Required City Required Postal / Zip Code
Are you a member of a Tri-M Honor Society Chapter in your school? *
N/A
If yes, please list the Tri-M Chapter # & Advisor Name
N/A
Upload a Headshot *
N/A
Upload file Capture image using webcam
Selfie's are ok as long as the student's entire head is in the picture. Please do NOT include full body shots and pictures with more than one person , pets, instruments, etc. in them.
Student Policy Information *
N/A

Students are required to read and agree to the following PMEA policies:

Anti-Bullying
Social Media
Code of Conduct
Hotel Guidelines

I understand that participation in a PMEA festival is a privilege and that membership may be forfeited if I fail to comply with any of the above rules. I understand that violation of the above rules will give administrative officials the right to exclude me from participation. If such violation(s) occurs, I understand that my parent/guardian will be immediately notified, and they will be expected to provide my immediate transportation home.

I understand.
Student Name for Confirmation of Above Agreement
N/A

Required First Required Last

Student Dietary Needs
Student Is (check all that apply) *
N/A
Please list food allergies if applicable (be specific - i.e. variety of nuts, fish, etc.) If None write N/A. *
N/A
Do you use an Epi-pen? *
N/A

Yes
No

If so, please note that a medical administration form must be completed and submitted to PMEA at All-State Registration).
Additional information you would like to share:
N/A
Parent/Guardian Name
N/A

Required First Required Last
Parent/Guardian Email *
N/A
Parent/Guardian Cell Phone # *
N/A

### ### ####

Thank you for completing the student information form. A copy of this form will be emailed to the director's email address listed.

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D10 Chorus Student Form

Student Medical Information

PMEA First Aid/Emergency Treatment Authorization

Student Dietary Needs

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