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Child's Name *

First Name

Last Name

Child's Birthdate *

MM

DD

YYYY

Parent *

First Name

Last Name

Parent

First Name

Last Name

Other Additional Adult who May Accompany Your Child? (nanny, grandparent,etc)

First Name

Last Name

Phone for Text *

(###)

###

####

Phone for Calls (if different)

(###)

###

####

By checking the boxes below, I acknowledge that I have read the below policies carefully and agree that should I cancel or not show up to a lesson without giving 24 hrs. notice, I will be held responsible for the full cost of lessons missed. Furthermore, I acknowledge that cancellation of a lesson package requires one month's notice for which no refund will be given. *

Excused Absences: Instructors will make reasonable efforts to make up lessons cancelled with 24 hrs. or more advance notice. However only one student excused absence is guaranteed to be made up during the semester makeup week (last week of the semester). Please keep contact information for your instructor on hand. Instructor absences will be made up, or in rare cases where this is impossible, refunded in full.

Unexcused Absences: Lessons cancelled without proper notice and/or no shows will not be made up. In the case of a student taking "Drop In" lessons, the full amount of the lesson will be charged.

Cancelling Lessons: Should a situation arise where you can no longer finish out a fully paid semester term, we require one month's cancellation notice. One month after notice is given, a refund may be issued for the remaining unused lessons.

By checking the box below, I acknowledge and agree to the conditions of the Liability Release. *

I agree to indemnify and hold harmless Music for Boulder, the Off Broadway School of Fine Arts, and Pine Street Church, their officers, employees, agents, consultants, subcontractors, insurers and representatives (collectively the Off Broadway School of Fine Arts at Pine Street Church), for any loss, damage, or injury to myself or my property in any way related to my participation in the programs of Music for Boulder or the Off Broadway School of Fine Arts. This release applies to me as well as any of my children, personal representatives, assigns, heirs, and next of kin. I authorize Music for Boulder and the Off Broadway School of Fine Arts in a medical emergency to seek emergency medical assistance at my expense.