Cary Fridley Private Lesson Registration
Please fill out this form to register for private lessons at BMCA. 
Please do your best to communicate with both your instructor and BMCA staff.
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Email *
Student's First Name *
Student's Last Name *
Student's Age *
Does the student have any experience with this instrument? *
Parent's name (if student is under 18)
Phone number (parent's if student is under 18) *
Street Address *
City *
State *
Zip *
Emergency contact *
Emergency contact phone number *
Do you/your child have any special needs we should know about? *
By submitting this electronic form I understand that participating in any class or workshop poses a possibility for physical injury.  I voluntarily agree, therefore, to assume all risk and responsibility for any such injury which may occur to me or my child at The Black Mountain Center for the Arts (BMCA).  I voluntarily waive my right to hold BMCA liable for any such damage, loss or injury. I acknowledge that there is a chance that I or my child could potentially be exposed to an illness including Covid-19 while attending programming. I agree to adhere to BMCA’s current safety protocols and I understand that participation in programs hosted by BMCA are at my own risk.  I authorize medical treatment which might be necessary in the event of an emergency. I understand that me or my child may be recorded or photographed for the purposes of promotion and the images may be displayed in print or on social media. I have read, understand, and agree to be bound by the above terms. Please enter your name below as your signature: *
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