Music Encounters Registration Form
This form and the $40 registration fee must be turned in before your student receives an instrument.
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Email *
Parent Email Address *
Student Name *
Student ID # (Lunch #) *
School *
Home Address *
Parent Phone Number *
Student Date of Birth *
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Student Grade *
Student Gender *
Student Ethnicity *
Is your student new to City Strings this year? *
Your student is being provided an instrument to use for the program.   These are donated to the program from other players who once used the instrument in the past.  They have been repaired and should be in good playing condition at the time it is received by the student.The care of the instrument is the responsibility of each family and it must be returned in the same condition that it was given to the student. The bow, case, rosin and shoulder sponge (for violins and violas) should accompany the instrument upon return.If the instrument comes back seriously damaged, lost, or otherwise not returned, the family will be responsible for a $200 fee to replace the instrument. The instrument must be kept out of the heat and cold as it may crack. Please never leave the instrument in a car or in the sunlight. It is extremely fragile and must be treated with great care. Please check the box below that you have read and approved these conditions: *
Required
Release Form: I hereby release, discharge, agree to indemnify, and hold harmless its Directors, officers, volunteers, agents, and employees from any and all claims, demands, injuries, and/or liabilities arising out of my child's participation in AUGUSTANA ARTS - CITY STRINGS, including without limitation, rehearsals and performances.I understand and agree that I am responsible for providing all hospital, surgical and/or medical treatment for my child.I hereby authorize the AUGUSTANA ARTS - CITY STRINGS, its successor, legal representatives, and assign the absolute and irrevocable right to use my child’s name, audio recordings, and/or video or visual images, or any portion thereof for any lawful purpose relating to the AUGUSTANA ARTS - CITY STRINGS.  I also authorize and consent to the use of any printed material in conjunction therewith.  I hereby waive any right that I may have to inspect or approve the use of my child's name, audio recording, video or visual image and/or printed material used in conjunction therewith.I hereby release, discharge, agree to indemnify, and hold harmless the AUGUSTANA ARTS - CITY STRINGS, its Directors, officers, volunteers, agents, and employees from any and all claims, demands, injuries and/or liabilities arising out of the use of my child's name, audio recordings, video or visual images, and/or printed material. *
Required
Student ID Information: In an effort to improve the City Strings program and fully understand the life-changing benefits it provides students, Augustana Arts is requesting your permission to review school-based information about your child.  This information will be provided to us by Denver Public Schools and will include age, race, gender, grades, attendance records and behavior records.  The information will be kept confidential and will not affect your child in City Strings. By checking the box below, you are allowing Augustana Arts’ managers to review certain information about your child.I understand my child’s information will only be used to review and improve the City Strings program and will not be shared, sold or in any way distributed to third party entities.   *
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