Music Discovery Week Registration 2025

Dates and Times

July 24, 2025 6:00-8:00 p.m.

July 25, 2025 6:00-8:00 p.m.

July 26, 2025 9:00 a.m.-2:00 p.m.

July 27, 2025 Performance 6:00 p.m.

Child's Name*

First NameLast Name

Birth Date

MonthDayYear

Age/Grade*

If registering a toddler please select the first checkbox. If your child is grade level, please pick two instruments that your child would be interested in learning for Music Discovery Week.*

T-Shirt Size*

Toddler Time Music Discovery Week Onsie/T-Shirt Design

Music Discovery Week T-Shirt (Youth T-Shirt Sizes)

Will your child/children stay for lunch on Saturday, July 27,2024 from 12:00 p.m.-1:00 p.m.? (Lunch is hot dogs, assorted chips, sodas, juice, and water.)*

Adding an additional child or children

YesNo

Add a child*

Parent/Guardian Information

Parent's Name*

First NameLast Name

Phone Number*

E-mail*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Alt. Phone Number

Does your child have any allergies, chronic illness, or medical conditions? If yes, please describe.

Additional Comments

Medical Release and Authorization

In consideration of being accepted by Rockville Baptist Church for participation in the following event, I, the undersigned, hereby give permission for any and all medical attention to be administered to my child/myself in the event of accident, injury, illness, etc. as deemed necessary by the leaders of this event. In the event of the necessity of such care or treatment as heretofore described, the undersigned agrees to hold harmless and indemnify said Rockville Baptist Church, its directors, employees and agents from any acts of malfeasance, and/or failure to act on the part of those chosen to administer medical care on behalf of the participant.

I do hereby release, forever discharge and agree to hold harmless Rockville Baptist Church and the directors thereof from any and all liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the participant that occur while said person is participating in the above described event, including recreation or work activities. The undersigned further agrees to hold harmless and indemnify said Rockville Baptist Church, its directors, employees and agents for any liability sustained by said acts of said participant, including expenses incurred attendant thereto.

Medical Release and Authorization Acceptance*

I agree to the above medical and legal release.

Photo Release

I grant Rockville Baptist Church the absolute right to copyright, re-use, publish, and republish by any medium, including electronically, any photos or videos of myself or my child(ren) or in which they may be included, that may be taken while participating activities at Rockville Baptist Church for any lawful purpose including publication, promotion, illustration, advertising, or historical archive.

Terms & Conditions*

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Date

Signature

Music Discovery Week Registration

Child Information