Impact POP! Fall Session

Impact POP Fall Session 2025

Oct 18-Dec 6, SATURDAYS 10:30-12, Ages 12-19, at Marsh Music Studio
Student Information
Student Name

First NameLast Name
Birth Date

MonthDayYear
Age
Musical Instrument(s)?
Please describe student's musical background
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian Information
Name

First NameLast Name
Home Number

Area CodePhone Number
Cell Number

Area CodePhone Number
E-mail
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number

Area CodePhone Number
Alt. Phone Number

Area CodePhone Number
Does the student have any allergies, chronic illness, or medical conditions? If yes, please describe.
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities during the selected class. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Marsh Music Studio and all its respective coaches and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected class sessions.

In case of injury to said child, I hereby waive all claims against Marsh Music Studio, including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.
Impact POP! School of Modern Music
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Fall Impact POP! School of Modern Music

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Impact POP Fall Session 2025