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Music & Movement Registration

Child's First and Last Name

Parent/Guardian First and Last Name

Child's Date of Birth

Month

Day

Year

Phone

Address

Medical Conditions (incl. Food Allergies)

Emergency Contact 1: Name & Number

Emergency Contact 2: Name & Number

All classes are Wednesday mornings, 8 AM to 8:45 AM on the following dates: July 23/July 30/August 6th/August 13th

Music and Movement @ Tiny Notes: 4x Wednesdays 8-8:45 AM$75

I consent to allow my child to be included in photos taken during class activities that may be used for Tiny Notes Music and Movement LLC media accounts and marketing.

I agree

ALL children and adults in the class MUST have socks and/or appropriate shoes on at all times! I understand I may not participate if I do not have socks and/or shoes.

I agree

I understand Tiny Notes is not liable for any food allergies or environmental allergies. Its is the parents responsibility to make staff aware if any allergies.

I agree

I understand that and agree to the requirement for a parent or legal guardian to be present at all times with my child(ren) while they are enrolled in this class.

I agree

Waiver and Release of Liability:

I agree that this Waiver and Release of Liability shall apply to each day I am at Tiny Notes Music and Movement LLC, regardless of the date that this form is signed below. I agree I will assume the risk and full responsibility for any and all injuries, losses, or damages, that might occur to my child or other family members while on the premises of Tiny Notes Music and Movement LLC or participating in any on-site and/or off-site program or activity; to the maximum extent of the law, I agree to waive and release any and all claims, suits, or related causes of action against Tiny Notes Music and Movement LLC, their owners, officers, employees or agents for injury, loss, death, costs or other damages to me, my heirs or assigns, or third party claims, suits or related causes of action asserted against the program arising from my conduct and/or my family’s conduct while participating in Tiny Notes Music and Movement LLC programs or activities. I further agree to release, indemnify, defend and hold Tiny Notes Music and Movement LLC harmless from any liability whatsoever for future claims presented by my child for any injuries, losses or damages. I also give Tiny Notes Music and Movement LLC consent to seek and accept medical treatment for my child.

Waiver and Release of Liability

I agree. By agreeing the above named parent or guardian agrees to the terms and conditions of the liability waiver and consent to treat.

Thank you for joining Tiny Notes Music and Movement LLC classes. By signing below and submitting this form you are verifying that all of the submitted information above is true and that you are the parent or legal guardian authorized to grant permission for the child to participate.

Signature

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