8th Note Music Studios Student Enrollment Form

This form must be filled out fully in order for students to participate.

STUDENT INFORMATION

Student's Name(Required)

Date of Birth(Required)

Parent / Guardian

First Name Last Name

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Home Phone

Mobile Phone(Required)

Email(Required)

Instrument(Required)

Teacher's Name(Required)

MEDICAL & EMERGENCY INFORMATION

MEDICAL CONDITIONS THAT ARE IMPORTANT FOR TEACHER TO KNOW ABOUT IN CASE OF EMERGENCY(Required)

PHYSICIAN AND CONTACT INFORMATION

EMERGENCY CONTACT PERSON THAT COULD BE REACHED DURING THE TIME OF THE CLASS(Required)

First Name Last Name

Phone(Required)

IN CASE OF EMERGENCY, AND THE EVENT THAT WE ARE UNABLE TO REACH FAMILIES OR EMERGENCY CONTACT PERSON IN A TIMELY FASHION, SIGN HERE TO GIVE PERMISSION FOR THE STAFF TO SEEK MEDICAL TREATMENT SUCH AS, BUT NOT LIMITED TO, CALLING AN AMBULANCE OR TAKING STUDENT TO AN EMERGENCY ROOM:(Required)

PLEASE ENTER YOUR FULL NAME. THIS WILL ACT AS YOUR DIGITAL SIGNATURE.

LIABILITY WAIVER

LIABILITY WAIVER Playing a musical instrument, like any sport or activity that requires the use of your muscles may from time to time contribute to, or cause pain to the musician. It is expected that all students will take responsibility for monitoring and treatment of any pain that they feel may be associated with, or aggravated by playing a musical instrument. We ask that all students at Eighth Note Music Studios sign the waiver of liability below in regards to both the study of the instrument and the use of the building that classes are taking place in. I, understand that the Teachers, owners, officers, landlords or volunteers at Eighth Note Music Studios cannot assume responsibility for any injuries to myself, my children, or my possessions that may occur before, during, or after my use of the building or study of an instrument. I agree to take full responsibility for my own and my children’s safety, and hold the Teachers, owners, officers or volunteers at Eighth Note Music Studios harmless from any and all liability claims arising from my study here.

SIGNATURE(Required)

PLEASE ENTER YOUR FULL NAME. THIS WILL ACT AS YOUR DIGITAL SIGNATURE.