Pineview Elementary - Violin Registration Form
Welcome to the free after-school violin program at Pineview Elementary! Currently offered to 5th graders on Tuesdays and Thursdays from 3:30 - 4:30 pm. After you fill out this registration form you will get a confirmation email from us letting you know your child is enrolled in the program.
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Email *
Student Name: *
Grade Level *
Gender *
Parent/Guardian Name: *
Relationship to Student: *
Parent/Guardian Phone Number: *
Parent/Guardian Email: *
Address (street and zip code) *
Is your child enrolled in extracurricular activities? *
Is your child receiving ESOL services? *
Child’s primary language? *
Languages spoken at home? *
Does your child have a special need/disability? *
If yes, how would you best specify your child’s need/disability? Please check all that apply
EMERGENCY CONTACT 1
Name: *
Relationship to student: *
Phone Number: *
Authorized to pick up: *
EMERGENCY CONTACT 2
Name:
Relationship to student:
Phone Number:
Authorized to Pick Up
Clear selection
Anyone NOT allowed to pick up your child? *
If YES, state their name and relationship:
Does your child have any known allergies?  *
If YES, list them here:
Does your child take any medications? *
Actions to take if medical care is needed
PRIVACY RIGHTS: I understand that pictures and/or videos will be taken during program activities/events. I give permission to the Tallahassee Symphony Orchestra to use said photos/videos of my student, family and myself to be used in educational, promotional, informational materials, or press media for positive public relations purposes. *
PROGRAM EXPECTATIONS: I understand that in order for this program to succeed and for my child to attain proficiency at violin and other musical skills, attendance and participation is mandatory. *
I understand my child is required to attend the full duration of the program *
I understand participation in this program is voluntary and at any time I may choose to withdraw my student(s). *
I understand my child is not allowed to leave unless picked up by an authorized adult. If someone else not stated on this form will be picking up your child, please reach out to the director at education@tallahasseesymphony.org and let them know who will be picking up your child. *
PERSONAL ELECTRONICS: I understand no personal electronics of any kind are permitted to be used during program hours. The TSO cannot be held responsible for loss or damage to any electronic devices.  *
Please Sign and Date via Digital Signature below to affirm you have read and agreed to all terms and conditions above. (Digital Signature will be regarded as an equal substitute to a handwritten signature). *
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