Group Class registration

Spring 2024 Group Classes at Rock 'n' More
23220 Maple Valley Black Diamond RD SE #14
Maple Valley, WA 98038

Student Information

Student Name*

First NameLast Name

Student's Age*

Student's pronouns (optional)

Parent / Guardian's Name*

First NameLast Name

Primary Phone Number*

Area CodePhone Number

Alternative Contact

Area CodePhone Number

Preferred Email*

example@example.com

Additional Email

example@example.com

Instrument(s)

If the student currently plays any instruments, list them here

How did you hear about us? (check all that apply)

Does the student identify as disabled*

YesNo

If you answered yes to the previous question, please tell us more about how we can help. Dace's Rock 'n' More Music Academy is committed to providing an inclusive environment where individuals with disabilities feel safe and secure.

Do you have any allergies or medical conditions that the instructor should know about?*

YesNo

Description of Allergies / Medical Conditions*

Parental Permission For Emergency Treatment

If emergency medical care is necessary and I cannot be reached, I authorize the Dace's Rock 'n' More Music Academy to act in my behalf in granting permission for my child to receive emergency medical treatment. Parents are responsible for all expenses incurred as the result of medical treatment.

I have read and agree to the above conditions*

YesNo

Release of Liability

I hereby waive, release, absolve, indemnify, and agree to hold harmless Dace's Rock 'n' More Music Academy, its directors, officers, organizers, sponsors, supervisory staff, participants, and any other affiliates; for, from, and against all liability because of any bodily injury, or property damage, known or unknown, which may occur or result from the participation of the above named child in any and all activities whether the result of negligence or for any other cause of Dace's Rock 'n' More Music Academy. I individually, and as a parent/guardian for my child, have read this release and understood all the terms. I execute it voluntarily and with full knowledge of its significance.

I have read and agree to the above conditions*

YesNo

Authorization to Produce and Use Audiovisual Materials

I hereby voluntary and without compensation authorize Dace's Rock 'n' More Music Academy to produce photographs, movies, videotapes, audio-tapes, and Power Point Presentations of the below named student. This authorization is given on the condition that the materials taken or produced will be used for the purpose of community education or program promotion. I understand Dace's Rock 'n' More Music Academy and its employees will not use these materials for compensation.

I understand that this grant of permission shall only be revoked by a written instrument delivered to the Executive Director of Dace's Rock 'n' More Music Academy. This consent shall remain in effect, unless revoked.

Student Name*

First NameLast Name

I have read and agree to the above conditions*

YesNo

Important Notes

· Classes will happen at the Rock 'n' More Loft which is right across the parking lot from Rock 'n' More's main studio space. For the first class students should meet at Rock 'n' More's main studio space and will walk to the Loft as a group with the instructor

· Dace's Rock 'n' More is not responsible for any classes missed by students

· Classes are non-refundable after the first class

· Payment must be made on our website and before the first class unless other arrangements have been made with us

· If you are in need of tuition assistance please contact info@rocknmore.org, we will always make sure anyone who wants to can participate regardless of ability to pay

I have read and agree to the above conditions*

YesNo

Confirmation E-mail*

example@example.com

Printed Name*

First NameLast Name

Signature of student or parent if student is under 18 years old*

After completing this form, please click Submit Form. You will receive a confirmation email. If you do not receive the email within a few minutes, please check your spam; otherwise, please contact us at info@rocknmore.org

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