Voice and Piano Lesson Registration Form

Voice and Piano Lessons

with Zoe McNulty

Family Contact Information
Family Contact Information

Please complete all information.
Father/Guardian Name (if student is under 18)

First NameLast Name
Mother/Guardian Name (if student is under 18)

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone (used for REMIND Texting APP)*

Area CodePhone Number
Second Cell/Home Phone

Area CodePhone Number
Emergency Contact

First NameLast Name
Emergency Contact Relation to Student(s)
Emergency Contact Phone

Area CodePhone Number
Who drives student(s) to class
Email*
example@example.com

Student Information
Please complete all information.
Name*

First NameLast Name
Date of Birth (if student is under 18)

MonthDayYear
Date
Current Grade/School System (if student is under 18)
Cell Phone Number (if applicable)

Area CodePhone Number
Student Email (if applicable)
example@example.com
Special Medical or Health Factors
Indicate voice or piano lessons
Student T-shirt size
Please select

Lesson Dates and Times
Summer voice and piano lessons will be held at:

Creative Arts Council
428 S. Oak St
Bluffton, IN 46714

Enter Door 10 and follow signs to the second floor music classroom.

Summer Lessons are 30 minutes and will be held on Wednesdays or Thursdays on the folllowing dates:

June (4th 5th) (11th 12th) (25th 26th)
2:00-5:30pm unless a time is requested differently.

July (2nd 3rd) (9th 10th) (23rd 24th) (30th 31st)
2:00-5:30 unless a time is requested differently
Summer Lessons are on Wednesdays 2:00-5:30pm and Thursdays 2:00-5:30pm. Please pick your first choice of lesson time. (Lesson times are not guaranteed)
Please pick your second choice of lesson time. (Lesson times are not guaranteed)

Waiver
Waiver
I, the undersigned, do not hold Creative Arts Council of Wells County (Creative Arts) or any of its staff or guest faculty responsible for any accident that may happen while attending classes, rehearsals or performances at Creative Arts or off site. I hereby authorize the instructor/staff of Creative Arts to act for me in any emergency requiring medical attention, if the above responsible adult(s) cannot be reached. I understand that all participating students are required to have their own accident insurance coverage.

I understand that photographs and recordings of students are sometimes used by Creative Arts for promotional purposes. These may include: website, social media, newspaper, television, etc.

I understand Creative Arts will add my contact information to email campaign/text messaging software in order to communicate information to me about Creative Arts programming. By signing this agreement, I give the Creative Arts Council permission to use my contact information for these purposes. I understand I am able to opt out of receiving both emails and text messages at any time.

I agree to pay the tuition payment before classes begin or create a payment plan with the Creative Arts office before classes begin.

By checking the box below, I agree to the above listed terms and conditions established by the Creative Arts Council of Wells County, and acknowledge that checking this box will act as a digital signature.
Please check the box below to signify that you have read and agreed to the above statement.*

I agree
Should be Empty:

Voice and Piano Lessons

Family Contact Information

Waiver