Group Lessons Registration

STEP 1: PARENT/GUARDIAN INFORMATION

Parent/Guardian Information - Group Lessons

Name

First Name

Last Name

Email Address

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

How did you hear about us?

STEP 2: STUDENT INFORMATION (fill out one form for each child you are registering)

Student Information - Group Lessons

Name

First Name

Last Name

Birthday

MM

DD

YYYY

Grade

School

Class you are registering for:

Intro to Guitar | Grades 2-5 | Tuesdays 5-6pm

Intro to Piano | Grades K-1 | Wednesdays 3:45-4:45

Intro to Piano | Grades 2-5 | Wednesdays 5-6pm

Anything else we should know?

AGREEMENT

I AGREE TO RELEASE AND HOLD PLAY MUSIC NYC (AND EACH OFFICER, DIRECTOR, EMPLOYEE, CONTRACTOR) HARMLESS FROM AND AGAINST ANY CLAIM, LIABILITY, CAUSE OF ACTION, INJURY, OR ANY OTHER LOSS OR OBLIGATION, EXCEPT TO THE EXTENT CAUSED BY THE INTENTIONAL MISCONDUCT OF PLAY MUSIC NYC (OR OF ANY OFFICER, DIRECTOR, EMPLOYEE, CONTRACTOR). IN THE RARE CASE OF INJURY OR SUDDEN ILLNESS, I HEREBY GIVE MY CONSENT TO HAVE THE ABOVE CHILD TREATED BY EMERGENCY MEDICAL PERSONNEL, A PHYSICIAN, OR SURGEON, AS WELL AS PLAY Music NYC STAFF TRAINED IN CPR/FIRST AID. I AGREE TO ASSUME FINANCIAL RESPONSIBILITY FOR ALL EXPENSES OF SUCH CARE. IT IS ASSUMED THAT PERMISSION IS GRANTED TO PLAY Music NYC TO REPRODUCE MY CHILD'S IMAGE ON ITS WEB SITE OR IN ANY FUTURE PROMOTIONAL MATERIALS.

Electronic Signature

BY TYPING MY FULL NAME IN THE BOX BELOW, I ACKNOWLEDGE THAT I HAVE THOROUGHLY READ, UNDERSTAND, AND AGREE TO THESE CONDITIONS.

STEP 3: PAYMENT

Check-out is fast and easy on our site! If you'd rather use another form of payment, please email us or call for details: info@playmusicnyc.com | 347-709-7722

Group Lessons Registration

Play Music NYC, LLC | 347-709-7722 | info@playmusicnyc.com

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