MRC Member Registration Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Summer Registration!
Summer Workshop fee is $200, and includes a tshirt, sticker, and membership to summer drop-in hours. Additional registrations per family include a 10% discount for each registration.

Summer drop-in membership is $40, or $10 for a five session punchcard.

To apply for a scholarship to cover fees, complete the last page of this form. If you are not applying for a scholarships, please proceed to the payments page after submitting this form if paying online.

Email *

Select the workshop you are registering for. *

Rising Stars day camp for students entering 1st-5th or 6th grade (June 10-13)

School of Rock day camp for students entering 6th-8th or 9th grade (July 8-11)

Make it Real workshop for students entering 9th-12th grade (July 29-August 1)

Girls camp (contact Shawna@dulutharmory.org for more information)

Summer Drop-in hours only (June 11-27, July 9-August 22).

Grade for Fall 2024 School year *

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

Grade 6

Grade 7

Grade 8

Grade 9

Grade 10

Grade 11

Grade 12

Student Full Name *

Preferred Name *

Date of Birth *

YYYY

Cell Phone Number

Home Address *

ZIP Code *

Parent/Guardian Name(s) *

Relationship(s) to Member *

Cell Phone Number(s) *

Email Addresses *

School Attending *

Preferred Gender Pronouns *

Does the member qualify for the free or Reduced lunch program at their school? (This information is for program funding purposes only).

Yes

Clear selection

Does the Member have any medical conditions or carry any medical supplies that we should know about? If yes, please explain. *

Does the Member have any dietary allergies or restrictions? If so, please list. *

Emergency Medical Treatment

If the member becomes seriously ill or injured while participating in MRC programs, including but not limited to during transportation to or from MRC, any authorized member may seek and obtain emergency medical treatment as he or she deems necessary. Additionally, I agree to release MRC from any claim whatsoever which may arise on account of any first aid, treatment, or service rendered in connection with the Member’s participation in the MRC programs.

Furthermore:

1) If the Member seems to need emergency medical treatment, I direct that the Member be transported to a nearby hospital.

2) If, after arranging for the Member’s transportation to a nearby hospital, reasonable efforts to contact me are unsuccessful, I then direct that reasonable efforts be made to contact at least one of the medical care providers listed below.

3) If neither I nor either of the medical care providers listed below can be successfully contacted to discuss emergency medical treatment for the Member, I consent to any emergency medical treatment considered necessary by the medical care personnel treating the Member. This consent to emergency medical treatment does not authorize surgery unless before the surgery, two physicians agree that surgery is necessary (one of whom must be one of the medical care providers named below – but only if available).

I agree to the terms of the Emergency Medical Treatment statement above. *

Yes

Required

Preferred Medical Care Provider, Name and phone:

Media Release

I hereby grant the Music Resource Center (MRC) a perpetual non-exclusive license to reproduce, perform, distribute and/or display any musical composition (including lyrics), sound recording, writing, or art work (including, but not limited to, any picture, drawing, or photograph) created at the MRC by the Member, existing currently or in the future (“Member Work”). This license includes the right to perform any musical composition or sound recording created at the MRC by the Member. I may withdraw this license at any time by giving MRC written notice ten days in advance.

I further authorize without limitation MRC, and those acting with its permission ad upon its authority, to use the Member’s name, photographic image (including, but not limited to, portrait, picture, video, or other reproductions), audio recordings of the Member’s voice, video recordings of Member, and likeness, written or in electronic format, and/or reproductions of the Member’s Work (collectively referred to herein as “Member Media Information”) in MRC’s publications, marketing and promotional materials, website, press releases, advertising media and/or for any other lawful purpose for the benefit of or relating to MRC. I waive the right to inspect or approve the finished product, including written or electronic copy, wherein the Member Media Information appears. I authorize MRC to use the Member Media Information, as described herein, on more than one occasion, without limitation to the number of times it is used, in perpetuity. I authorize MRC to reproduce, or cause to be reproduced and used, the Member Media Information described herein. I further agree to sign additional releases and waivers as may be required from time to time. I agree that I shall not be entitled to receive any compensation for such use, and I hereby release MRC, its successors and assigns, and those acting with its permission and upon its authority, from any liability, responsibility, or claim that may arise by reason of any exercise of the authority granted above.

I agree to the terms of the Media Release statement above. *

Yes

Required

I understand that the MRC has an open-door policy and is not permitted to keep my student from leaving the premises. *

Yes

Required

I understand that the MRC is not responsible for my student's behavior, and students may be asked to leave at any time if behaving inappropriately. I understand the staff and volunteers are there to help students work toward their music goals. If students behave in any way that seriously disrupts others, requires staff or volunteers to redirect them repeatedly, or causes others to feel unsafe, they will be asked to leave the premises. *

Yes

Required

How did you learn about the Music Resource Center? *

Select your payment plan. *

I plan to pay by card online by following the link after submitting this form. (Go to dulutharmory.org/donate and select "music program fee" to make a payment for an MRC program).

I plan to mail a check or drop it off at Sacred Heart during current drop-in hours. (Checks can be made out to the Armory Arts and Music Center at 1626 London Road #779, Duluth MN 55812.

I plan to apply for a scholarship.

I have more than one student I am registering for. (There is a 10% discount for additional registration. Two summer workshops: $380. Three summer workshops $460).

Required

If not applying for a scholarship, skip the remaining questions. If applying for a scholarship, please read the following.

For Scholarship Applicants Only:

If paying a membership fee would be a financial hardship, we have grant money available for participation scholarships. To apply for a scholarship, please respond to the following questions below:

1. What would you like to get out of your time at MRC?

How often to you plan to attend the MRC?

3. What instruments/skills do you hope to learn or improve on during your time at the MRC?

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of Armory Arts and Music Center. Report Abuse

Forms