2017-18 Music Together Registration Form
Mother/Guardian name *
Your answer
Father/Guardian name *
Your answer
Child's Name *
Your answer
Child's Birthdate *
MM
/
DD
/
YYYY
1st enrolling sibling's name
Your answer
1st enrolling sibling's birthdate
MM
/
DD
/
YYYY
2nd enrolling sibling's name
Your answer
2nd enrolling sibling's birthdate
MM
/
DD
/
YYYY
Who would you prefer be the primary contact with Creative Keys? *
Class day and time *
No preference
1st choice
2nd choice
Not available
Wednesdays 9:30-10:15 am
Thursdays 9:30-10:15 am
Home address *
Your answer
Mother's cell phone *
Your answer
Mother's email *
Your answer
Father's cell phone *
Your answer
Father's email *
Your answer
Is it okay to text your cell phones? *
Would you like to be added to the studio closed Facebook group where families share ideas, stories, pictures, and videos? If yes, what is your Facebook name so we can add you?
Your answer
How do you prefer to receive studio communication? *
Please check all you prefer
Required
Additional contact information for parents (home phone, work phone, etc.)
Your answer
Custody issues we should be aware of or persons who may not attend or pick up
Your answer
Name, relationship, and contact information for additional parents or significant adults in the child's life
Your answer
Other family members who play an instrument (which instrument?) or are comfortable singing with your student
Your answer
How often does the primary contact check email? *
Your answer
Who should we contact in an emergency if parents can't be reached? Name, contact information, and relationship. *
Your answer
Who is responsible for payment on this account? If not parents, please provide name, phone number and email address of person responsible for payment. *
Your answer
Photo and Video Release *
I hereby give permission to Creative Keys to take photographs and videos of my child(ren) and use them in printed or online formats for advertising and educational purposes. Photos and videos may be used in the studio scrapbook, advertising materials, lesson demonstrations, professional presentations and blogs, and on studio owned websites, blogs, and Facebook pages. The studio follows online safety rules in this matter. Photos taken by the teacher OR that are shared with the teacher by other parents or students of gatherings or performances become the property of the studio, may be edited, and can be used at the discretion of the teacher in regards to the studio. I expressly release Lynnette Barney, Creative Keys, and Music Together from all claims which I have or may have for invasion of privacy, defamation, or any other cause of action arising out of exhibition or distribution of any materials in which my child(ren) may appear. This Consent is binding upon heirs and future legal representatives.
I have read the Music Together Polices at www.creativekeysmusic.com/music-together and agree to abide by all the terms and conditions in that document. *
Please type parent's full name AND today's date to act as an electronic signature
Your answer
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