Parental Consent Form 2022-2023
This form is required for all students who apply to participate in any of the San Diego North Chapter CAPMT programs.
Student Name (LAST, FIRST) *
Student Age *
Parent/Guardian Full Name *
Parent/Guardian Email *
Parent/Guardian Contact Phone Number *
CONSENT & RELEASE AGREEMENT: By checking YES below, you acknowledge that you have read and agree to this Term and Condition. By checking YES below, you acknowledge you are 1) age 18 or older or 2) the parent or legal guardian of the applicant under age 18. I hereby unconditionally release and discharge the California Association of Professional Music Teachers (CAPMT); CAPMT agencies, departments, directors, officers, employees, volunteers, agents; San Diego North Chapter CAPMT collaborating partners; and all other persons and entities involved with any of the SDNC CAPMT programs from any and all claims, demands, liabilities, damages, costs, and all other expenses that may arise in connection with the applicant's participation in the selected SDNC CAPMT program. I understand that the SDNC CAPMT programs have a physical element to it. I agree and understand that by signing this Waiver, the applicant is physically able to participate as a volunteer or participant in the selected SDNC CAPMT. I hereby certify that the applicant is in good physical condition and that the applicant is able to participate in the selected SDNC CAPMT program without harm to the applicant or others. I agree to voluntarily assume all risks, known or unknown, of injuries, however caused to the applicant, even if caused in whole or in part by the action, inaction or negligence of the host or collaborating partners, sponsors, individuals, and groups involved in the selected, and to hold SDNC CAPMT or collaborating partners, sponsors, individuals, and groups involved in the selected SDNC CAPMT program free and harmless from any liability or damages for any injuries that the applicant may sustain. *
Required
MEDIA WAIVER: By checking YES below, you acknowledge that you have read this Term and Condition. By checking YES below, you also acknowledge that you are 1) age 18 or older or 2) the parent or legal guardian of the applicant under age 18. I hereby grant my consent to the California Association of Professional Music Teachers (CAPMT) to photograph, electronically record, transfer, or film the applicant for distribution in all media at any time, all public performances and appearances in or associated with the SDNC CAPMT selected program without any compensation or remuneration. I also grant to SDNC CAPMT the right to use any such recorded performances, interviews, quotations or photographs of the applicant; and the right to use the applicant's name, voice, image, and likeness in connection with a SDNC CAPMT event, including but not limited to: publication in books, magazines, pamphlets, advertising, and newspapers; and on television, radio, internet, and social media channels, without any compensation or remuneration. *
Required
CHILDREN'S ONLINE PRIVACY PROTECTION ACT (COPPA) PARENTAL PERMISSION FORM: By checking YES below, you acknowledge that you have read and agree to this Term and Condition. By checking YES below, you acknowledge you are the parent or legal guardian of the child applicant (“Minor”). The Minor’s information is only used in connection with the selected SDNC CAPMT program and is limited to the information requested below. It is our practice to only obtain information regarding children under the age of 13 from the child’s parent or guardian and not from the child directly. The Minor’s parent or legal guardian must consent for the collection, use or disclosure of the information requested below. CAPMT will not share identifiable information of a child with any third party. CAPMT will only send our promotional communications or newsletters to the parent or the legal guardian who provided the child’s information to us, and the California Association of Professional Music Teachers (CAPMT) will not link, sell, trade, or otherwise transfer to outside parties’ personally identifiable information for any child under the age of 13. If the parent or guardian does not give their consent within a reasonable time, CAPMT will delete the parent or guardian’s online contact information from our records. At any time you can review, change or delete your child's personal information, or revoke your parental consent by sending us an e-mail to the corresponding event chair at capmt.sdnc@gmail.com. To protect your privacy and security, we may require you to speak with a representative or take additional steps or provide additional information to verify your identity before we provide any information, make corrections, or disable your child’s registration. I authorize my Minor to fully participate in the selected SDNC CAPMT program. I understand that I, the legal guardian of the Minor indicated above, will provide the Minor’s necessary information in order to participate in the selected SDNC CAPMT program. I consent to this practice. I understand that I may withdraw my permission granted herein, as set forth in the CAPMT Privacy Policy. I also understand that it is important to provide accurate information in this consent form in case CAPMT needs to contact me for any reason. *
Required
Parent/Guardian/Adult Student Signature (type full name) *
I, the participating student, am 18 years or older. *
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