AMPlified Student Info Form

BeatZone Student Information Form

This form is to be completed by a parent/guardian for any child who plans to be a part of the BeatZone after school program. This is a 8 -10 week music production and songwriting program. A student must be nominated or invited in order to join this group. This form must be completed before your child can begin the program. **Availability is on a first-come, first- serve basis.
Student Information
What school or site is he/ she applying for ?
Full Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Age*
Grade in School*
Shirt Size*
Gender*

MaleFemale
Student Phone Number (if applicable)

Area CodePhone Number
Parent/Guardian Information
Full Name*

First NameLast Name
Main Phone*

Area CodePhone Number
Other Phone

Area CodePhone Number
E-mail*
Additional Parent/Guardian (Optional)
Full Name

First NameLast Name
Main Phone

Area CodePhone Number
Other Phone

Area CodePhone Number
E-mail
Emergency Information
Contact Name*

First NameLast Name
Relationship*
Phone Number*

Area CodePhone Number
Allergies
Describe any medical problems, conditions or special concerns regarding your child
Other Information
School Name*
How did you hear about our program? (If person, please share name)*
(ex. facebook, flyer, teacher Ms. Smith, student Mary.)
Field Trip Permission Form

During the course of the year, students may participate in educational and performance-based field trips. We may travel by bus, van, car and/or by foot. Parents and guardians will be notified of dates, times and locations for field trips. I give permission for my child to attend all field trips given by the Ascend through Music Program.
Parent/Guardian Electronic Signature *
Living Classrooms Media Release (for a minor, under the age of 18)

In consideration of my child's engagement as a subject and other consideration herein acknowledged as already received, and without further consideration or compensation now or in the future, I hereby give Living Classrooms Foundation and its legal representatives and assigns the right and permission to publish images of my child and statements by my child as captured through photography, videography, audio recording, and written communication while participating in Living Classrooms and as a program graduate. I further authorize modification of these images and statements for correctness and artistic effect so long as the changes do not result in intentional and harmful misrepresentation. Without time constraint and without further notification, these images and statements may be used--with or without appropriate identification of my child by name, school affiliation, age, and/or affiliation(s) with Living Classrooms Foundation--in any Living Classrooms publication or communication (eg. web pages, multimedia presentations, television commercials, promotional literature, fundraising collateral materials, advertising, and participant recruitment campaigns) whether print, electronic, or broadcast.
Parent/Guardian Electronic Signature *
Covid & Code of Conduct Policies
COVID-19 PROTOCOL AND SAFETY:
- Periodic hand washing and sanitizing breaks.
- Students showing 2 or more symptoms, or a fever of 100.4 or higher will not be able to participate that day.
- Bathrooms and classrooms will be sanitized/disinfectant periodically throughout the day.
- Keep your child home if they are sick or exhibiting Covid symptoms.
- Immediately contact Director or staff if your child has been exposed to COVID or diagnosed with COVID.
CODE OF CONDUCT

Students will be respectful towards staff, interns and volunteers and other students in the program.
Students will respect the space, instruments and equipment, using all items appropriately and as directed.
Parents will communicate in a timely manner if unable to attend a scheduled time.
I understand the safety and conduct policies, and agree to work with my child to follow the rules and policies of the program. I understand that the rules are established to help all of the children enjoy a safe environment
Signature
6. Is there anything else about your child that you would like for us to know?
1. Please be aware that this program runs approximately 10 weeks, with the goal of developing technical, expressive and creative skills. In order for your child to get the most benefits and success out of this program, it is important he/she is able to attend consistently, and demonstrate approprite behavior and a positive attitude. As a parent/guardian, we ask for your support in their learning, growth and participation in this program by committing to consistent attendance, and communicating with us if a conflict or issue arises.
"I understand the purpose of this program, and commit to supporting my child as a participant." Parent/Guardian Electronic Signature
Should be Empty:

BeatZone Student Information Form

Student Information

Parent/Guardian Information

Emergency Information

Other Information

Field Trip Permission Form

Living Classrooms Media Release (for a minor, under the age of 18)

Covid & Code of Conduct Policies