Columbus Music and Art Academy Registration for 2020 Summer Online Classes
Email address *
Student First Name *
Your answer
Student Last Name *
Your answer
Age *
Your answer
School District *
Your answer
Grade (2020-2021) *
Gender *
Choir - Session 1 *
Art Class - Session 1 *
Choir - Session 2 *
Art Class - Session 2 *
Parent/Guardian First Name *
Your answer
Parent/Guardian Last Name *
Your answer
Parent/Guardian Relationship to Student *
Your answer
Parent/Guardian Phone *
Your answer
Parent/Guardian Emergency Phone *
Your answer
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.
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.
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Responsible party first and last name *
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A copy of your responses will be emailed to the address you provided.
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