Summer SMART Registration Form Enrolled families

I give permission for my child {studentsName} to participate in Building Bridges Through Music Inc. programs and be transported by Building Bridges Through Music Inc. staff to and from these activities, field trips, and school centers. I understand that my medical coverage is the primary insurer for my child and will not hold Building Bridges Through Music Inc. responsible in case of an accident.

Parent/Guardian Initials *

Building Bridges Through Music Activity Permission

I give permission for images in print and electronic form and videos taken of my child during the program to be used for public relations purposes, in the newsletter, brochures, annual reports, and for publicity on our website, radio, television, and newspapers.

Parent/Guardian Initials *

PARENT HANDBOOK SIGN-OFF SHEET

I have read and understood all the policies in the Building Bridges Through Music Inc. After School Program Handbook.

I agree to follow the handbook policies accordingly. I do understand that all policies will be enforced, and failure to comply with the policies is a reason for immediate termination.

Parent's Signature

How did you hear about Building Bridges Through Music

Newspaper - Radio - Television Internet School Flyer Family /Friend

The following is used for grant writing purposes only. It will not be shared and your name will never appear next to the information.

Household Income level

Under $17,000 $17,000 to $20,999 $21,000 to $24,999 $25,000 to $49,999 $50,000 and above

Ethnic Background

Asian/Pacific American Black / African American Latino / Hispanic American Indian Native American White / European American Other

Please verify that you are human *

Parent/Guardian Name *

Please type your name

BBTM Office use only:

Date Received

Date Entered

Initials

Registration Fee Paid

Photo Permissions

Date of admission

Field Trips

Registration Form for Enrolled families ONLY