Colorful Melody Presents: Alice in Wonderland

Student Name*

First NameLast Name

Yes my student will be heading to 4th-9th grade in the fall.

Student Grade in School Fall 2018*

Age*

Date of Birth*

Primary Phone Number*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Select

Student School

Student Email (If Applicable)

example@example.com

Student Phone (If Applicable)

Area CodePhone Number

IMPORTANT PARENT INFORMATION

Please note we will be communicating and distributing important information via e-mail such as scheduling info. forms, reminders, etc. Please write the e-mail address of the adult that this information should be sent to, as the Contact e-mail. The contact e-mail and the contact name should be for the same individual. Due to the number of students we have enrolled, we are ONLY ABLE to issue ONE SET of papers - to be given to the contact name. (This includes schedule info and all performance information). Please make any necessary copies and coordinate distribution of appropriate paperwork and info to all other parties.

Contact Name*

First NameLast Name

Relationship to Student

Cell Phone*

Area CodePhone Number

Work Phone*

Area CodePhone Number

Contact Email*

example@example.com

INSTRUCTIONS

If you would like to add a second contact you may do so below.

Contact 2 Name

First NameLast Name

Relationship to Student

Contact 2 Phone Number

Area CodePhone Number

Contact 2 Work Phone Number

Area CodePhone Number

Contact 2 Email

example@example.com

Workshop Policies *

I agree there is no credits or refunds for missed days of camp.I agree to bring lunch for my child. (Snacks will be provided)I agree that camp tuition is non-refundable after June 11th, 2018.I agree that all camp tuition is due in FULL by June 1st, 2018.I agree to ENM Music, 7 Keys Music and/or teachers is hereby granted permission to take photographs of students for use in brochures, web sites, posters, advertisements and other promotional materials created by the school and/or performing company. Permission is also hereby granted for the school and/or performing company to copyright such photographs in its name.I agree that ENM Music and teachers reserve the right to dismiss students based on what we deem "inappropriate behavior or violence" with no refund. We want to ensure a safe and positive experience for all students participating.

June 18th- June 29th (Monday - Friday)

8:30 - 5:00 pm normal workshop hours7:30 - 6:00 pm extended workshop hours (one time $40.00 fee)

Liability Release Waiver Form *

In consideration of receiving music, and dance instruction including special classes in art and staging, etc....and other good and valuable consideration, hereby release and forever discharge the said ENM Music, 7 Keys Music, United Community Charter School, Kerisha Council, Tiffany Cooper, Heather Pipkin and all other instructors their assistants, agents, servants and/or employees and their families, of any and all claims for damage or damages of any kind, nature or description; more particularly which may grow out of receiving performing arts instruction or participation in recess or other physical exercise or movement. You must further release ENM Music, 7 Keys Music, United Community Charter School Kerisha Council, Tiffany Cooper and Heather Pipkin from any and all demands, claims, causes of action, suits or liabilities whatsoever, of every name and nature, both in law or in equity; more especially on account of participation in classes taken at United Community Charter School.*

By checking this button you agree to the above Liability Release Waiver Form