Music Camp Form
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Email *
Student Name *
Date of Birth *
School *
Address *
City *
State *
Zip Code *
Home Phone  *
Mother's Name *
Mother's Cell  *
Father's Name *
Father's Cell *
Emergency Contact Name *
Emergency Contact Cell *
Camp Choice *
Please tell us about your child's musical background. *
What goals do you have for your child attending this camp?  *
Camp activities will be held at Mountain View Music, 217 E. Main Street, Front Royal, Virginia. 
Are you interested in other music course offerings, such as a music theory class, group piano, or sharing your music with others?  Examples might be a Saturday morning playing at a nursing home or doing a demonstration class at the library.
Minor Child Photo/Video Release
I, the parent or legal guardian (name entered below) of the student listed at top of this form, grant Mountain View Music my permission to photograph or take videos of my child for student recognition, publicity, advertising, and web content. I understand that my child’s name will NEVER appear alongside or with photos or videos that are released outside of the studio.  Furthermore, I understand that no royalty, fee or other compensation shall be come payable to me by reason of such use. I also understand that I may revoke this permission at any time.
Signature of Parent or Legal Guardian *
I agree to the terms of the Minor Child Photo/Video Release *
Assumption of Risk and Waiver of Liability Related to Injury and Illness
On behalf of myself, my child, and any successor guardian of my child, I hereby release, covenant not to sue, and agree to hold harmless Tapsak Enterprises, LLC, Mountain View Music, their employees, staff, volunteers, representatives, and members on any and all claims, liabilities, harm, damages, costs, or expenses related to any injury or illness, including the contraction of COVID-19.
I agree to the terms of the Risk and Waiver of Liability Related to Injury and Illness *
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