Summer Workshop Registration form

First Name

Last Name

Date Of Birth

Age

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First Name

Last Name

Date Of Birth

Age

First Name

Last Name

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First Name

Last Name

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Please provide information about any allergies, chronic illnesses, or medical conditions the student may have.

Please provide any instructions if the student is prescribed an inhaler.

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Informed Consent and Acknowledgement I hereby provide my consent for my child to participate in all activities organized by Hesperia Music Academy during the selected camp. By accepting my child's participation, I acknowledge and accept all the risks and hazards that may be associated with the activities. I release, absolve, and hold harmless Hesperia Music Academy, along with its officers, agents, and representatives, from any and all liability for any injuries sustained by my child while traveling to, participating in, or returning from the camp sessions. In the event of any injury to my child, I waive all claims against Hesperia Music Academy, including its teachers, affiliates, participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of the premises where the event takes place. It is understood that there are inherent risks of injury associated with all music-related activities. By providing my approval, I acknowledge that I have read and understood the above terms and agree to them on behalf of my child's participation in the camp at Hesperia Music Academy.

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Medical Release and Authorization As the parent and/or guardian of the named camper, I hereby grant authorization for qualified and licensed medical professionals at Hesperia Music Academy to diagnose and treat my minor child in the event of a medical emergency. This authorization is applicable when immediate attention is deemed necessary by the attending medical professional to prevent further endangerment of the minor's life, physical disfigurement, physical impairment, or any other undue pain, suffering, or discomfort if delayed. I understand that in the event of a serious illness, the need for major surgery, or a significant accidental injury, the staff will make every attempt to contact me as quickly as possible. However, I acknowledge that in emergency situations, efforts to reach me may be prioritized for the well-being of my child. I also grant permission to the Hesperia Music Academy and its affiliates, including directors, teachers, and team parents, to provide necessary emergency treatment to my child before their admission to a medical facility. I willingly and voluntarily authorize this release, solely for the purpose of authorizing medical treatment under emergency circumstances, to protect the life and well-being of my named minor child in my absenc

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Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

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Summer Workshop Registration form

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