SongBirds Registration

Please fill out one registration form per child registering. This registration form is for the program being offered Fridays, November 6th - 27th, 2015. 3:45pm-4:45pm. To be held at The Soundgarden in Coombs. The program fee for the 4 session program is $35.
All information in it is confidential, and will not be shared with anyone. Sharon will contact you with information about the program, when she receives this registration, and a reminder with any other information you may need, the week of the program.

SongBirds Children's Singing and Music Enrichment Program REGISTRATION FORM

* Indicates required field

Name *

First

Last

Participants Age *

Participants Gender *

Parent/Guardian's Name *

First

Last

Parent/Guardian's Phone Number *

Parent/Guardian's Email *

Dr's Name and Telephone Number. *

Care Card Number *

Please list any medical concerns, including any allergies *

Please tell me a bit about your child, and their musical interests. *

Release of Liability, Waiver of Claims and Assumption of Risks

By signing this document, you waive certain legal rights, including the right to sue.

I understand that there could be risks involved with my child’s participation in the SongBirds Singing and Music Enrichment Program. I assume these risks. I also assume any and all other risks associated with my child’s participating in this program, including but not limited to falls, injury, contact with other participants, all such risks being appreciated by me. I hereby for myself, my heirs, executors, administrators and assigns release, save harmless and indemnify all persons comprising the group commonly referred to as Esteem Vocals, their respective agents, instructors, volunteers, or anyone else on their behalf, (the Releasees) from and against any and all existing and future claims, actions, costs, expenses and demands in respect to death, injury, damage, loss or expenses to my child’s person or property, whether forseen or unforeseen and wheresoever and howsoever caused, arising out of or in the course of my child’s participation in this SongBirds Singing and Music Enrichment Program and related events and notwithstanding that the same may have contributed to or occasioned by any act or failure to act, including without limitation, negligence of the Releasees or any of them. I hereby acknowledge having read this release and waiver and by accepting I understand and accept its terms.

I have read and understood the above and accept its terms. *

Yes, I agree to the above Release of Liability No, I do not wish to to sign and register my child in this program.

I give permission to allow my child’s name and photo to appear in the local newspaper, The Soundgarden’s or Esteem Vocals website and other promotional websites and publications. *

Yes, That's fine with me No Thanks Please talk with me about it beforehand

Submit