Class Registration Form - Homeschool Strings

RM_Stats

Info
Quantity
STUDENT 1 OF 6
STUDENT 2 OF 6
STUDENT 3 OF 6
STUDENT 4 OF 6
STUDENT 5 OF 6
STUDENT 6 OF 6
SIGNATURES AND AGREEMENTS
PAYMENT
Page 12
Page 13

Parent Email^*

Enter email again^*

Parent First Name^*

Parent Last Name^*

Address

Address Line 1 ^*

Address Line 2

City ^*

State or Region ^*

Zip ^*

Home phone

Please fill out at least one of the three options.

Cellular Number

Please fill out at least one of the three options.

Other Phone Number

Please fill out at least one of the three options.

Emergency Contact Information

Contact Name^*

Contact Relationship^*

Emergency Contact Phone^*

Number of Students^*

Number of Students (used for calculation)^*

Insert a numerical value ranging 1-6

Note: When you are finished entering students, leave the following pages blank and click “next” until you arrive at the “Signatures and Agreements” page. There are a total of 6 pages for student information.

Student 1 First Name^*

Input 1st student information, or your own information if self-registering

Student 1 Last Name^*

Student 1 Birthdate^*

Student 1 Email

Used for Class Assignments & Homework

Student 1 Instrument(s)^*

Add

Delete

Instruments student has musical experience with. Include all instruments (e.g. piano, strings, and woodwinds). Insert "none" if student has not yet played an instrument.

Student 1 Experience^*

Add

Delete

Years of experience and ability level for each instrument listed above. For example, instrument A, should go in experience field A.

Student 1 Instrument Playing in School Year^*

Add

Delete

Student 1 Returning^*

Check "Yes" if student has participated in Homeschool Strings in the past.

Student 1 Additional Information

You may skip this page if finished entering student information.

Student 2 First Name

Student 2 Last Name

Student 2 Birthdate

Student 2 Email

Student 2 Instrument

Add

Delete

Instruments student has musical experience with. Include all instruments (e.g. piano, strings, and woodwinds). Insert "none" if student has not yet played an instrument.

Student 2 Experience

Add

Delete

Years of experience and ability level for each instrument listed above. For example, instrument A, should go in experience field A.

Student 2 Instrument Playing in School Year

Add

Delete

Student 2 Returning

Student 2 Additional Information

Medical Problem/Allergy/Etc. (if applicable). Please include anything our staff and teachers need to know about student.

You may skip this page if finished entering student information.

Student 3 First Name

Student 3 Last Name

Student 3 Birthdate

Student 3 Email

Student 3 Instrument(s)

Add

Delete

Instruments student has musical experience with. Include all instruments (e.g. piano, strings, and woodwinds). Insert "none" if student has not yet played an instrument.

Student 3 Experience

Add

Delete

Years of experience and ability level for each instrument listed above. For example, instrument A should go in experience field A.

Student 3 Instrument Playing in School Year

Add

Delete

Student 3 Returning

Student 3 Additional Information

You may skip this page if finished entering student information.

Student 4 First Name

Student 4 Last Name

Student 4 Birthdate

Student 4 Email

Student 4 Instrument(s)

Add

Delete

Instruments student has musical experience with. Include all instruments (e.g. piano, strings, and woodwinds). Insert "none" if student has not yet played an instrument.

Student 4 Experience

Add

Delete

Years of experience and ability level for each instrument listed above. For example, instrument A, should go in experience field A.

Student 4 Instrument Playing in School Year

Add

Delete

Student 4 Returning

Student 4 Additional Information

You may skip this page if finished entering student information.

Student 5 First Name

Student 5 Last Name

Student 5 Birthdate

Student 5 Email

Student 5 Instrument(s)

Add

Delete

Instruments student has musical experience with. Include all instruments (e.g. piano, strings, and woodwinds). Insert "none" if student has not yet played an instrument.

Student 5 Experience

Add

Delete

Years of experience and ability level for each instrument listed above. For example, instrument A, should go in experience field A.

Student 5 Instrument Playing in School Year

Add

Delete

Student 5 Returning

Student 5 Additional Information

You may skip this page if finished entering student information.

Student 6 First Name

Student 6 Last Name

Student 6 Birthdate

Student 6 Email

Student 6 Instrument(s)

Add

Delete

Instruments student has musical experience with. Include all instruments (e.g. piano, strings, and woodwinds). Insert "none" if student has not yet played an instrument.

Student 6 Experience

Add

Delete

Years of experience and ability level for each instrument listed above. For example, instrument A should go in experience field A.

Student 6 Instrument Playing in School Year

Add

Delete

Student 6 Returning

Student 6 Additional Information

CONSENT FOR MEDICAL TREATMENT: As the parent or legal guardian of the above-named child(ren), I give
my consent for emergency medical care prescribed by a fully licensed physician or dentist. This care may
be given under whatever conditions are necessary to preserve the life, limb, or well-being of my dependent(s).

RELEASE OF LIABILITY: I hereby release, discharge, and/or otherwise indemnify and hold harmless Home
School Strings and its representatives from any claim, damage, cost or liability by or on behalf of the
registrant(s) as a result of participation in the Home School Strings Program at any location.

DAMAGES: I agree to be solely responsible for the instrument(s) in my child’s possession, for any maintenance and repairs of that instrument, whether owned or rented. I agree to cover the costs of repair or
replacement of an instrument damaged, destroyed or lost due to my child’s actions. I agree to cover the
replacement costs of music lost while in my child’s possession.

PHOTO/VIDEO: I give permission to Home School Strings to take and use photographs/videos of the
aforementioned children. I understand that the media will become the property of the Home School
Strings and I agree that the media may be used in multimedia presentations, videotapes, books, supplemental products, and related advertising materials, such as brochures or websites.

Handbook: My child(ren) and I have read the HSS Handbook (located here) and agree to abide by its policies.

Terms and Conditions Signature^*

Please type your name to agree to the terms and conditions laid forth above. Signing you name certifies that you (the person registering) is over the age of 13.

STUDENT CONDUCT: I understand that I am expected to have good behavior and speech at all times. I
understand that there is no running around indoors or outdoors. I may read or do homework quietly in the
sanctuary or conference room. I may eat lunch or talk quietly in the foyer or outside.

Student 1 Signature^*