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Middle School Concert
September 24, 2022 - Colton's Point MD
Registration Form

Calling all "Middle Schoolers" to join us for a Praise and Worship Concert September 24th 2022 located on the St. Clement’s Museum Grounds.

Gates open 7pm

Pre-pay fee $5 per student before September 24th / Payment at the gate $10 per student

"ALL STUDENTS TO BE ACCOMPANIED BY AN ADULT/CHAPERONE and a waiver is required to be signed per student.

For additional information please contact: southernmarylandroots@gmail.com

Attendees - Group Parents/Guardians, Teachers and Youth Ministers must complete and submit this form with payment of $5 PREPAID per person ($10 at the door). Youth Ministers/Teachers must be Virtus certified and have a 1 to 10 ratio of leader to students when participating. (Parents/Guardians, Teachers and Youth Ministers are free.)

Middle School "Concert Only" registrations do no come with a shirt.

If you have any questions regarding this form please email us at southernmarylandroots@gmail.com.
Concert flyer
- Click Here - for more information
The maximum number of form submissions has been reached. This form is currently not available.
- Parent/Guardians, Youth Ministers, and Teachers Contact Info Completing the form
- Choose Your Leadership Role REQUIRED Please fill out this field.
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Parish or School Name REQUIRED Please fill out this field. Please enter valid data.
- Parish or School City, State, and Zip
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Email REQUIRED
  A registration receipt will get sent to this email.
  Please fill out this field. Please enter an email address.
- Cell Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Will you be participating? REQUIRED Please fill out this field.
- Are you Virtus certified? REQUIRED Please fill out this field.
- Youth Participant Information: Please use the space below to register up to ten (10) participants not including parents/guardians, youth ministers, and teachers:
- Participants REQUIRED Please fill out this field.
  
  Participant 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Grade Level REQUIRED Please fill out this field.
  
  Gender REQUIRED Please fill out this field.
  
  Parent/Guardian Name REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Email REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Cell Phone Number REQUIRED Please fill out this field. Please enter valid data.
  
  Participant 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Grade Level REQUIRED Please fill out this field.
  
  Gender REQUIRED Please fill out this field.
  
  Parent/Guardian Name REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Email REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Cell Phone Number REQUIRED Please fill out this field. Please enter valid data.
  
  Participant 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Grade Level REQUIRED Please fill out this field.
  
  Gender REQUIRED Please fill out this field.
  
  Parent/Guardian Name REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Email REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Cell Phone Number REQUIRED Please fill out this field. Please enter valid data.
  
  Participant 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Grade Level REQUIRED Please fill out this field.
  
  Gender REQUIRED Please fill out this field.
  
  Parent/Guardian Name REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Email REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Cell Phone Number REQUIRED Please fill out this field. Please enter valid data.
  
  Participant 5
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Grade Level REQUIRED Please fill out this field.
  
  Gender REQUIRED Please fill out this field.
  
  Parent/Guardian Name REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Email REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Cell Phone Number REQUIRED Please fill out this field. Please enter valid data.
  
  Participant 6
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Grade Level REQUIRED Please fill out this field.
  
  Gender REQUIRED Please fill out this field.
  
  Parent/Guardian Name REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Email REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Cell Phone Number REQUIRED Please fill out this field. Please enter valid data.
  
  Participant 7
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Grade Level REQUIRED Please fill out this field.
  
  Gender REQUIRED Please fill out this field.
  
  Parent/Guardian Name REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Email REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Cell Phone Number REQUIRED Please fill out this field. Please enter valid data.
  
  Participant 8
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Grade Level REQUIRED Please fill out this field.
  
  Gender REQUIRED Please fill out this field.
  
  Parent/Guardian Name REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Email REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Cell Phone Number REQUIRED Please fill out this field. Please enter valid data.
  
  Participant 9
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Grade Level REQUIRED Please fill out this field.
  
  Gender REQUIRED Please fill out this field.
  
  Parent/Guardian Name REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Email REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Cell Phone Number REQUIRED Please fill out this field. Please enter valid data.
  
  Participant 10
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Grade Level REQUIRED Please fill out this field.
  
  Gender REQUIRED Please fill out this field.
  
  Parent/Guardian Name REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Email REQUIRED Please fill out this field. Please enter valid data.
  
  Parent/Guardian Cell Phone Number REQUIRED Please fill out this field. Please enter valid data.
- Attending Parents/Guardians, Teachers and Youth Ministers Information
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- I am 18 years of age or older. REQUIRED Please fill out this field.
- Gender
- Are you Virtus certified? REQUIRED Please fill out this field.
- Price per Participant CONCERT ONLY - tickets will be $10 at the door.5.0
- I have read the guidelines and regulations provided in the waiver documents and agree to abide by all as required to attend this event. I agree to email a complete Parent/Guardian Waiver form for each participant and a Adult Waiver form for every adult participating. (Forms Below. Email to southernmarylandroots@gmail.com.)
  I Agree Please select this field.
Total:

Submit

Proceed to Payment

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REQUIRED FORMS - PLEASE COMPLETE THE APPROPRIATE FORM AND EMAIL TO SOUTHERMARYLANDROOTS@GMAIL.COM
- Parent/Guardian Waiver Form
- Adult Waiver Form

Southern Maryland Roots Youth Group

Chaptico, MD

Concert flyer

REQUIRED FORMS - PLEASE COMPLETE THE APPROPRIATE FORM AND EMAIL TO SOUTHERMARYLANDROOTS@GMAIL.COM