MusicMates Returning Participant Registration Form September

Name of Participant

First NameLast Name

Name of Parent/Caregivers/Guardian

First NameLast Name

E-mail

Home Phone Number:

Area CodePhone Number

Cell Phone Number:

Area CodePhone Number

Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Emergency Contact

Birth Date of Participant:

MonthDayYear

Has anything in the participant's situation changed that we should be aware of?

Program(s) of Choice:

Payment Agreement

I have and understood.I would like to prepay for the entire session. Please send me an invoice.I would like to provide prepaid checks dated for the first of each month in this session.

Please indicate your consent to have pictures and/or videos of the participant published on social media such as Facebook and the MusicMates website by selecting Yes or No:

YES, I consent to pictures and/or videos of the participant being published on social media such as Facebook or the MusicMates website.NO, I do not consent to pictures and/or videos of the participant being published on social media such as Facebook or the MusicMates website.

Thank you for registering as a MusicMates participant ... again!

We look forward to making more music with you!

MusicMates

Agreements

Waiver