2026-27 Simply Strings Registration

Date

i.e she/her, they/them, he/him etc.

Please enter a valid phone number.Format: (000) 000-0000.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Please enter a valid phone number.Format: (000) 000-0000.

In order for the Simply Strings staff to administer medications you must provide ALL of the items below:

Medication Authorization Form listing all of the medications brought to Simply Strings
Parent/guardian signature at the bottom of the Medication Authorization Form
Physician signature at the bottom of the Medication Authorization Form
A pharmacy label showing the name of the student, medication, strength and dosage instructions on EVERY prescription medication including inhalers, nasal sprays, cream, disc’s, etc.
Over the counter medications must be in their original containers – medication in baggies or pill-a-day containers will not be accepted.

Please print the form below and have your physician sign it, you may email a picture to Miranda Ronan of the signed form below or bring it to the first day of Simply Strings, 9/28/2026.

Please enter a valid phone number.Format: (000) 000-0000.

RELEASE AND WAIVER OF CLAIMS:
I, individually and/or on behalf of my minor child(ren), hereby release and hold Santa Rosa Symphony Institute for Music Education, Simply Strings, their board, trustees, employees, directors, volunteers, and/or other acting on their behalf, harmless from negligence and any and all claims that I or my child have arising from walking home from camp. This release will remain in effect for the duration of the 2026-27 Simply Strings year.

ASSUMPTION OF RISK:
I, individually and/or on behalf of any minor child(ren), expressly and specifically assume any and all risk of injury, illness, death or property damage resulting from allowing my child to walk home from the program. I, individually and/or on behalf of any minor child(ren) understand that walking home unsupervised may be dangerous. Once I sign, I am saying that I understand the risks involved and accept all of the risks.

INDEMNIFICATION:
I, individually and/or on behalf of any minor child(ren), shall hereby defend and indemnify Santa Rosa Symphony Institute for Music Education Simply Strings, Board, employees, directors, staff, volunteers, and/or others acting on their behalf from any and all claims arising from allowing my child(ren) to walk home from Simply Strings.

Date

2026-27 Simply Strings Registration

Simply Strings Student Information

Parent/ Guardian Information

Health and Safety Information

Medication

Disabilities / Learning Accommodations

Pick-Up / Walk Home Authorization