Summer Camp Registration
Musica Gloria Piano Studio https://www.musicagloriapiano.com
Musica Gloria Piano Studio is offering a piano and art camp for grade school students 1st-5th Grade. Open to elementary pianists who are currently in lessons. Also piano exploration in a group setting for students with little to no experience. Art activities and music games. Sign up for one or more sessions.
Studio location: 2329 W 15th Street, Suite B, Edmond OK 73013.
Camper Name
First Name
Last Name
School and Grade
Age
Do you play the piano?
Yes
Yes, just a little
No
Do you play another instrument? If so, please let us know!
Please list food allergies if applicable. None, please type N/A.
Parent/Guardian Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
In case of emergency, please contact (Name, Relation, Number)
If you are an Epic student and intend to use your Activity Fund, please provide your student ID. A deposit of $40 is required with this form. The studio will bill your Activity Fund for $140. If there are sufficient funds, the $40 deposit will be returned to you. Any amount not covered by your Activity Fund, will be billed to you.
RELEASE / DISCLAIMERI do hereby assume full responsibility for any and all damages, injuries (including death), or losses that I may sustain or incur, if any, while attending, engaging, practicing, participating or witnessing activity and/or certain event(s) occurring in or about the premises or at any offsite location. I hereby assume full risk, waive all claims and release and hold Musica Gloria Piano Studio, individually or otherwise, harmless for any and all liability, claims, suits, damages, expenses, fees, actions, or rights of action or judgments as a result of injury or death to myself or members of my family or heirs, or my guests, or damage, destruction or loss to my property, which in any way relates to, arises out of, or is in any way connected with my presence on the premises, or my participation in events of activities thereon, or the negligent acts or omissions of the releases or any other third party. I am fully aware and understand that Musica Gloria Piano Studio does not have on or about the premises, or employ or contract with any medical services, provisions for ordinary or emergency medical services. In consideration of my participation in Musica Gloria Piano Studio and the use of its premises or facilities, I hereby release and covenant not to sue the owner of the premises (releases),shareholders, directors, officers, employees, representatives, agents, affiliates and lessees from any and all claims resulting from any physical injury that may occur to me while participating in any program or event sponsored by Musica Gloria Piano Studio. I HAVE READ AND FULLY UNDERSTAND THE ABOVE RELEASE/WAIVER AND FULLY UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING THIS WAIVER VOLUNTARILY.
By checking the box, I am the legal parent or guardian of the camper listed. I have read and agree with the release above.
I agree to permit Musica Gloria Piano Studio to take photographs and/or video and audio recordings during the camp and performance events. I understand that such photographic images, video, or audio recordings of my child may be used for promotional purposes. Audio and video recordings made at camp may be shared with ensemble partners and their families.
I have read and agree with the media release above.
I have read and agree with the media release above, but please omit my child's name.
I do not permit any photographs or video of my child.
My Products
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Session 2 July 14-17 (9:00 am - 12 noon)
$
140.00
Quantity
1
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Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit
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