Columbus Music and Art Academy Registration for 2018-2019 School Season
Registration is throughout the year.
Student Information
Student Status *
First Name *
Please capitalize the first letter
Your answer
Last Name *
Please capitalize the first letter
Your answer
Age *
Your answer
Date of Birth *
Please enter the date of birth in the format: MM-DD-YYYY
Your answer
Grade (2018-2019) *
Gender *
Full Home Address *
Street address, City, State, and Zip code
Your answer
Student's Email (only for Vocalise Members)
Your answer
School Name (2018-2019) *
N/A - if not known or not applicable
Your answer
School District *
Your answer
Name of School Music Teacher *
Choir applicants only, others - N/A
Your answer
Name of Private Voice Teacher *
N/A if not applicable
Your answer
Choir Polo Shirt Size *
Required for choir applicants only, others choose N/A.
Select Classes
Choir *
If you are not sure, call or email us
Art Class (unlisted groups are full) *
Music theory *
Parent/Guardian 1 Information (Primary Contact)
Please keep the same primary contact for all registered siblings.
Parent/Guardian 1 First Name *
Please capitalize the first letter
Your answer
Parent/Guardian 1 Last Name *
Please capitalize the first letter
Your answer
Parent/Guardian 1 Relationship to Student *
Your answer
Parent/Guardian 1 Occupation *
Your answer
Parent/Guardian 1 Email *
We request a valid email address because all correspondence, including schedule updates, will be by email. Notify us timely if your email address changed.
Your answer
Parent/Guardian 1 Home Phone *
Please enter phone number in the format:XXX-XXX-XXXX
Your answer
Parent/Guardian 1 Emergency Phone *
Please enter phone number in the format:XXX-XXX-XXXX
Your answer
Parent/Guardian 2 Information (Emergency Contact)
Parent/Guardian 2 First Name
Your answer
Parent/Guardian 2 Last Name
Your answer
Parent/Guardian 2 Relationship to Student
Your answer
Parent/Guardian 2 Occupation
Your answer
Parent/Guardian 2 Email
Your answer
Parent/Guardian 2 Home Phone
Please enter phone number in the format:XXX-XXX-XXXX
Your answer
Parent/Guardian 2 Emergency Phone
Please enter phone number in the format:XXX-XXX-XXXX
Your answer
Discounts and Payment Options
Early Bird Discounts *
Other Discounts - select 1 discount *
If your child is eligible for multiple discounts, select the largest discount. If you apply for financial assistance (20% choir discount) bring or mail a copy of the letter confirming that your household is eligible to receive food stamps.
Select Payment Option - You will receive an electronic invoice by email. Must be paid before the next class. *
Additional Information
How did you learn about us (new students only)? Returning students use N/A. *
Your answer
Full name of a current student who referred us to you (new students only). If not applicable - N/A. *
Your answer
CMAA Policy and Tuition Plan Acknowledgement
By submitting this form I acknowledge that I have read and understand Columbus Music and Art Academy’s Policies and Procedures published at http://www.cmaacademy.org/policies.pdf.

I understand that I will receive an electronic invoice and will have to pay it in full upon receipt.
I understand that selection of the multiple payment plan requires signing the credit card authorization form.

*
Required
Waiver, Release and Hold Harmless Agreement
On behalf of myself and my child, I grant permission for my child to participate in Columbus Music and Art Academy programs. I specifically agree that I will indemnify and hold harmless Columbus Music and Art Academy, its Directors, Officers, Teachers, and Contractors ("Released Parties") from any and all losses, claims, actions, or proceedings of any kind or character which may be presented or initiated to recover money, property, or damages for any injuries to persons or damages to property suffered in association with my child's participation in Columbus Music and Art Academy programs or any related activities. Furthermore, I expressly release Columbus Music and Art Academy, its Directors, Officers, Teachers, and Contractors from any and all claims for consequential damages, including but not limited to claims for lost wages, that may result from injuries suffered by the student while participating in the Columbus Music and Art Academy programs or any related activities. I covenant for myself, my estate, my executor, my heirs, my child, and my assigns not to initiate any claim or file suit against Columbus Music and Art Academy in respect to any personal injury, property damage, or death my child may experience or sustain arising directly or indirectly from participating in the programs of Columbus Music and Art Academy or related activities including but not limited to choir tours, choir performances, choir rehearsals and art exhibitions. I additionally covenant for myself, my estate, my executor, my heirs, my child, and my assigns not to initiate any claim or file suit against Columbus Music and Art Academy and the Released Parties for recovery of the materials involved in my child's participation in Columbus Music and Art Academy programs and related activities. On behalf of my child, I hereby give Columbus Music and Art Academy permission to photograph, audiotape and videotape my child without limitation by any means. I give Columbus Music and Art Academy permission to use such photographs, audio and video recordings ("Materials") for the purposes of promoting Columbus Music and Art Academy. I grant these permissions on a perpetual, irrevocable, royalty-free, and non-exclusive basis. I further agree that Columbus Music and Art Academy may copy, reproduce, adapt, edit, summarize, copyright, publish, exhibit, distribute, and otherwise use or may authorize to use all or portions of the Materials in any manner, including but not limited to: Print Media, The Internet, Television, Radio, Audio CDs, Video/DVD, Successor Technologies. Columbus Music and Art Academy may utilize the Materials in subsequently developed technologies and media for the uses set for above.
*
Required
Responsible party first and last name *
Your answer
AFTER SUBMITTING THE FORM YOU WILL RECEIVE A CONFIRMATION EMAIL WITH INSTRUCTIONS HOW TO MAKE A PAYMENT. If you do not receive the confirmation email, call us at 614-309-2546 or email us at http://www.cmaacademy.org/email-us.htm.
Submit
Never submit passwords through Google Forms.
This form was created inside of Columbus Music and Art Academy. Report Abuse - Terms of Service