REGISTRATION for Session beginning October 1, 2011
INSTRUCTIONS: Print this form by clicking on "File", then
"Print" on your computer menu bar.
Fill out the form and mail it before September 28, with payment, to
The Joy of Music LLC, 305 West Main St Suite D, Washington, IA 52353
Fill out the form and mail it before September 28, with payment, to
The Joy of Music LLC, 305 West Main St Suite D, Washington, IA 52353
DATE OF BIRTH
CURRENT AGE ACCOMPANYING ADULT
RELATIONSHIP TO CHILD
MAILING ADDRESS
PHONE
ALT. PHONE Permission to photograph:
I
[do] [do
not] (circle one) give permission for
(child and/or accompanying adult) to be photographed
during sessions of Music With Me. Photos will become the property
of The Joy of Music, LLC and may be used for advertising purposes including,
but not limited to, The Joy of Music, LLC website, fliers and mailings.Assumption of Risk and Waiver of Liability:
I
acknowledge that
participation in this program requires my own alertness to the safety of my
child(ren) and therefore hereby release The Joy of Music, LLC from such
responsibility.By signing below I agree to all terms and conditions above.
Signature
Date (parent or
guardian)