ShamRock Camp, Group Lesson & Class Registration Form

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Student Musicians name *

Age of Musician

Guardian *

Cell Phone *

Address (#, Street, City, State, Zip) *

Email *

Which camp or group program are you registering for? Please include name and dates for camp. *

Instruments to be played in the camp/group (including singing) *

What is your level of playing? *

Beginner

Self-taught

Taken lessons for 1+ years

Other:

Have you participated in any of our past camps or group programs? (date, location, instruments played) *

Special Needs/Allergies *

How did you find out about ShamRock School of Music's Summer Camps or Group Programs? *

PERMISSION TO USE PHOTOGRAPH/VIDEO RECORDINGS OF STUDENT..... I, the parent/guardian/self (if 18+) give my permission for ShamRock School of Music to use photographs and/or video recordings of my child/self, as well as the following types of information regarding my child/self, in articles about our facilities in newspapers, magazines, newsletters, websites, television stations, radio, social media, and any promotional advertising including brochures. Name. Participation in recitals, community events, or concerts. Photographs of child participation in recitals, community events, or concerts. I release ShamRock School of Music, its officers, employees, agents, and successors, from any and all claims, demands, actions, causes of action, suits, damages, and judgements as a result of the use of the above information about my child/self in the publication and other activities described above. (Sign below if you agree to these terms) *

CANCELATION POLICY- Please note that 45 days written notice is required for a refund for any camps, group lessons, or classes, less a $25 administration fee. Written notice WITHIN 30 days of the camp, group lesson, or class, a 50% refund can be given. Within 7 days of camp, group lesson, or class starts, NO refunds will be given. By signing below you understand and agree to these terms. *

I release ShamRock School of Music, its officers, employees, agents, and successors, from any and all claims, demands, actions, causes of action, suits, damages, and judgements as a result of the use of the information about my child/self in the publications and other activities described above. I have read and understand the refund policy stated on the next previous part of this document with my signature below. *

I DO NOT want the types of information described above regarding my child or myself given to newspapers, magazines, newsletters, websites, television stations, radio, and any promotional advertising including brochures. I have read and understand the refund policy and as stated on the reverse side of this document with my signature below. *

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