Strings Over Strife Youth Registration 
Youth Registration Form and Parental Consent
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Email *
Youth Participant Name *
Youth Participant Age *
Youth Participant Date of Birth *
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Youth Participant Home Address *
Youth Participant email  *
Youth Participant phone number *
Parent/Guardian Name *
Parent/Guardian Phone number *
Emergency Contact Information *
List any Food Allergies or Sensitivities
(Dietary restrictions)
 *

Parental Permission:

I give permission for my child to participate in the Strings Over Strife Music Education Summer Enrichment Program. I understand that my child will be engaging in activities related to music instruction, group activities, and potentially outdoor excursions as part of the program. I authorize program staff to seek emergency medical treatment for my child if necessary and agree to inform program staff of any changes to the participant's medical information or emergency contact details.

Media Release: I give permission for Strings Over Strife to use photographs, videos, or recordings of my child for promotional or educational purposes related to the program.


 *
Date: *
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Time: *
Time
:
A copy of your responses will be emailed to the address you provided.
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