Student's Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Student 2 Name

First Name

Last Name

Student 2 Date of Birth

MM

DD

YYYY

Student 3 Name

First Name

Last Name

Student 3 Date of Birth

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent's Name *

First Name

Last Name

Parent's Phone Number *

(###)

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Preferred Days of the Week *

Select as many as applicable.

Monday

Tuesday

Wednesday

Thursday

Friday

Legal Release *

I, the undersigned, do hereby grant permission to Panharmonic Music Studio (aka, “The Studio") to post my and/or my child’s story, photo, or other items, hereinafter referred to as “Materials,” to be used in social media (e.g., Facebook and/or Instagram) and/or other promotional material for The Studio.

I acknowledge and agree that no sums whatsoever will be due to me as a result of the use and/or exploitation of the “Materials” or any rights therein.

I acknowledge that my child is under 18 years old and lacks the legal capacity to enter into binding agreements. Accordingly, I have read this Release and consent to my child’s inclusion in the Materials will not contest the rights granted in this Release, and shall assist and support you in any and all legal proceeding for affirmation of this Agreement, should you choose to have a court of law affirm this Agreement.

Yes

No

Acknowledgment of Studio Policy *

I have read and understand Panharmonic Music Studio's Policy and agree to abide by its terms and conditions while I/my child is taking lessons.

Acknowledgment of Participant Agreement, Waiver & Release *

I have carefully read this agreement, waiver, and release and fully understand its contents. i am aware that this is a release of liability and a contract between myself and Redemption Church, as well as Panharmonic Music Studio and i sign it of my own free will.

Student or Parent/Guardian Electronic Signature *

First Name

Last Name

Parent/Guardian's Birthday *

This confirms that you are over 18 and the actual parent/guardian.

MM

DD

YYYY