Consent Form - Citywest Hub '23/'24

In order for a person under 18 years of age to take part in any Music Generation South Dublin course or activity, this form must be completed and submitted to us. It will be kept in a secure place and will not be used for purposes other than for us to contact you about Music Generation South Dublin activities.
Email: citywestmusichub@gmail.com
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Email *
Student Name(s) (Include siblings here also) *
Your Instrument & 2nd/3rd instrument (if applicable)
Parent/Guardian Name and Phone Number *
Emergency Contact Name and Phone Number *

Please state if your child has any medical conditions/allergies/additional needs that MGSD need to be aware of

I consent to my child participating in the indicated Music Generation South Dublin activity
 *

Photos and Videos may be taken and used by Music Generation South Dublin for promotional use

 *
In the event that a student's class is cancelled by the Musician or by Music Generation, the class will be postponed or refunded (€8 for group classes, €12 for Duo classes)

In the event that a student misses a class due to illness or otherwise, the class cannot be postponed or refunded. *
Required
Signed (please type your name and today's date) *
Submit
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