Chambers Music Workshop Registration Form

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Student's Name: *

Parent/Guardian's Name: *

Address: *

City: *

State: *

Zip Code: *

Phone Number: *

Email: *

Student's Age: *

Grade just completed: *

School attended last year: *

Music teacher's name: *

Years of study: *

Recent repertoire studied: *

Parent Agreement

I certify that the above information is correct, and I agree to allow my child to participate in the festival's program and activities.

Parent's or Guardian's Name:

Student Agreement

I promise to obey the rules of the workshop and the university, to participate in the workshop's activities, and to try to profit by the instruction.

Student's Name:

Photo/Video Release: I hereby consent to the use of photographs/videos of my child/dependent/self, and/or any copies of this photograph/video in any editorial and/or promotional material produced and/or published by Southeastern Louisiana University. This includes usage in commercial advertising and the Internet. I understand that signing this release does not guarantee use of the photos/videos.
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I agree

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This form was created inside of Southeastern Louisiana University.