Bamboleo Con Imelda at Circle of Musical Friends

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Winter 2019 Registration Form

Email *

New Families

Please answer all questions on the form.

Returning Families

Please fill in the parent and child's name and select the class you are enrolling. Other sections can be updated as needed.

Do you agree to receive email messages?

Yes

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Parent Name (First, Last) *

Home Address(Street)

City, Zip Code

Who will be taking child to class? *

mother

father

grandparent

legal guardian

other

Required

What is the name of the person taking the child to class?

Cell Phone *

Do you agree to receive text messages?

Yes

Clear selection

Student Information

Student Name (First, Last) *

Gender

Male

Female

Date of Birth(Month/Day/Year) *

Do you speak Spanish to your child at home?

Yes

Clear selection

Which Amiguitos Class are you enrolling? Please check one. *

Thursday, 4:30pm-5:30pm (Colombia: January 24-February 28) Open to 4-6 year olds

Friday, 10:00am-11:00am (Colombia: January 25 - March 1)

Friday, 4:30pm-5:30pm (Colombia: January 25 - March 1)

Saturday, 3:30pm - 4:30pm (Colombia: January 26 - March 16, No class on Feb. 9 nor March 2)

Required

Media Consent Release and Liability Waiver

Circle of Musical Friends will use photographs and video of students in the Bamboleo con Imelda classes for archival, training, or public relations purpose, which includes but not limited to the web site, newsletters, flyers and notice board. I hereby give Circle of Musical Friends permission to publish, exhibit, and distribute these materials. I understand that Circle of Musical Friends owns the copyright to the multimedia material in which I, or my child may appear. Circle of Musical Friends will assure that it conveys positive images of children and reflect early childhood recommended practices Please signify your consent to post images and/or video on the Bamboleo con Imelda website, managed by Circle of Musical Friends. If you are consenting to use your child’s photo/video, you are hereby releasing Circle of Musical Friends from any and all liability resulting from or connected to the publication.

By checking below I give my consent

For individual or group pictures of my child to be displayed.

For individual or group video of my child to be displayed.

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Release of Liability

Circle of Musical Friends presents Bamboleo con Imelda classes that involves singing, dancing or creative movement, and the use of developmentally appropriate percussion instruments. Physical activities, such as dance, carry a risk of injury to participants. I hereby release Circle of Musical Friends of any liability whatsoever arising out of any injury, damage or loss which may be sustained by myself or my minor children during the course of my involvement with Circle of Musical Friends studio.

Consent *

I have read this waiver agreement, understand its contents, and accept and assume such risks.

Required

Attendance

Regular attendance and arriving 10 minutes before class is scheduled to begin is encouraged. In case of contagious illness, we ask your cooperation in keeping your child at home when they are sick. Every effort will be made to schedule a make up class within the 6-week session at another scheduled class.

Registration

The required materials fee includes 2 bilingual story books (digital/printable PDF format, digital music/storytelling, a lyrics/vocabulary activity book (digital/printable PDF format), and supplies for in-class arts and crafts.

Registration Fees (are due by the 1st day of class) *

Student Registration Fee ($80 six-week session + $30 materials fee )

Sibling Registration Fee ($80 six-week session +$15 materials fee)

How did you hear about Bamboleo Con Imelda?

A copy of your responses will be emailed to the address you provided.

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