Student's Name *

First Name

Last Name

Birth Date (mm/dd/yyyy) *

MM

DD

YYYY

Name of Person Completing Registration *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(000) 000-0000

(###)

###

####

Instrument *

Which instrument does participant play?

Violin

Viola

Cello

Bass

Emergency Contact Name *

Provide complete contact information for one adult, other than the person filling out the registration, who we can contact in case of emergency. Emergencies can arise even for adult students. Please list one trusted individual even if the student is over the age of 18.

First Name

Last Name

Emergency Contact Phone Number *

(000) 000-0000

(###)

###

####

Photography *

Student may be photographed or video recorded for the Arts Hub's promotional materials including, but not limited to, social media, website, and/or printed media.

Yes

No

Class Check-Out Procedures *

Minor may sign themselves out of class.

Minor is to be signed out by an authorized person.

Adult Student - N/A

My child will be taking the bus from school to the Hub? *

(Please note: Parents must arrange bus transportation with GO Rightway in advance. You can find bus links and contact information on our Home page after you submit this registration form.)

Yes

No

Adult Participant - N/A

Parent/Guardian or Adult Participant Electronic Signature *

I have read and accept the Arts Hub Policy and Procedures.