The Child Prodigy Series Sarasota, Florida

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The Child Prodigy Series
$100 PAYMENT IS DUE THE BEGINNING OF EACH month. CHILD MAY BEGIN AT ANY TIME.
                         
E-mail addresses and cell phones are required for class confirmation. Print form below, complete, then mail to : Marcy Gilroy  A Prelude to the Classics 4224 Escondito Circle  Sarasota, Florida 34238
Parent(s)
Caregiver's Name
Full Mailing Address   

Email
City       State    Zip
Phone(s):   Home  Work
Child #1 New (  )   Returning (  )                                  Child # 2 New(   )   Returning  (   )
Date of Birth
Month/Day/Year __________________		Female  (    )
Male     (    )
 Color of piano (red, black, white, or pink)    __________                          Delivery Date  of piano requested    _____________         
Is Child in Preschool Program   Y  (  )   N  (   )   Female  (   )
Male      (   )

Has your child ever played an instrument, if yes, what type, how long   _______________________________________________________     

  

Has parent or caregiver ever played an instrument, how long      ____________________________________________________________          

Any allergies and preference for snacks and drinks                  _____________________________________________________________            

Print, sign, send with check for $100 per month, child may begin at any time and attend any and all classes  to Marcy Gilroy   A Prelude to the Classics The Child Prodigy Series 4224 Escondito Circle  Sarasota, Florida 34238  You may also bring in registration with you to your first class.    

 THIS RELEASE MUST BE SIGNED AND SUBMITTED ALONG WITH THE ABOVE REGISTRATION FORM IN ORDER FOR YOUR CHILD TO RECEIVE CLASS MATERIALS AND BE ABLE TO PARTICIPATE IN CLASS. RELEASEINDEMNIFICATION AND MEDICAL TREATMENT AUTHORIZATION I voluntary agree to my child's participation in activities put on by A Prelude to the Classics The Child Prodigy Series. I acknowledge that these activities may involve my child's performing physical movements in accompaniment to the singing or music in the class, and that such physical movements are moderate and are not intended to cause my child to experience any physical strain or overexertion and I attest that my child is in good health and physically and psychologically able to participate in such physical activities. I understand that after the first class, no refunds will be issued. For as long as my child is enrolled or participating in any activity put on by A Prelude to the Classics The Child Prodigy Series, I hereby assume all risk of injury to my child attendant to his/her participation in A Prelude to the Classics The Child Prodigy Series activities, and I hereby agree to forever release, waive and discharge A Prelude to the Classics The Child Prodigy Series, its officers, directors, shareholders, employees, teachers agents and successors and assigns from any and all demands, claims, causes of action and damages in connection with any injury to my child, in connection with his/her participation in A Prelude to the Classics The Child Prodigy Series which injury is not directly caused by the gross negligence or intentional act of A Prelude to the Classics The Child Prodigy Series, its officers, directors, shareholders, employees, teachers or agents. I further agree that neither I nor my assignees will make a legal claim against or attach the property of A Prelude to the Classics The Child Prodigy Series, its officers, directors, shareholders, employees, teachers, agents and successors and assigns for injury or damage caused by my child's participation in A Prelude to the Classics The Child Prodigy Series activities unless caused by the gross negligence or intentional act of A Prelude To the Classics The Child Prodigy Series, its officers, directors, shareholders, employees, teachers or agents. I further agree to release A Prelude to the Classics The Child Prodigy Series from liability for any of my child's property that may be lost, stolen or damaged while my child is participating in A Prelude to the Classics The Child Prodigy Series activities. I also forever release, waive and discharge A Prelude to the Classics The Child Prodigy Series, its officers, directors, shareholders, employees, teachers, agents and successors and assigns from any  and all demands, claims, causes of action and damages in connection with any injury to me suffered on A Prelude to the Classics The Child Prodigy Series premises or while entering or leaving such premises  which injury is not directly caused by the gross negligence or intentional act of A Prelude to the  Classics The Child Prodigy  Series, its officers, directors, shareholders, employees, teachers or agents. There may be occasions where my spouse or my child's caregiver will accompany my child to A Prelude to the Classics The Child Prodigy Series classes; in the event that such person is injured on A Prelude to the Classics The Child Prodigy Series premises or while entering or leaving A Prelude to the Classics The Child Prodigy Series premises, I agree to indemnify and hold A Prelude to the Classics  The Child Prodigy Series harmless from and against  any and all demands, claims, causes of action and damages in connection with any injury to such person suffered on A Prelude to the Classics The Child Prodigy Series premises or while entering or leaving such premises which injury  is not directly caused by the gross negligence of A Prelude to the Classics The Child Prodigy Series its officers, directors, shareholders, employees, teachers or agents. I agree that in the event of a medical or psychological emergency involving my child, A Prelude to the Classics The Child Prodigy Series, its employees, teachers and agents have the authority and may in their sole discretion contact 911 emergency services as well as the emergency contact person designated below. I understand that A Prelude to the Classics The Child Prodigy Series is not a medical services provider and is not expected to provide medical or psychological services, and that A Prelude to the Classics The Child Prodigy Series will make its best effort to communicate with my designated contact person in an emergency. I acknowledge that all costs incurred in providing such emergency medical or psychological services to my child initiated by A Prelude  to the Classics The Child Prodigy Series as provided above are my and not A Prelude to the Classics The Child Prodigy Series responsibility. This Release, Indemnification and Medical Treatment Authorization shall bind my personal representatives, heirs, executors, administrators, Assigns and all the members of my family for so long as my child is enrolled in A Prelude to the Classics The Child Prodigy Series or participating in any activity put on by A Prelude to the Classics The Child Prodigy Series. 
Date: ________________   Name of Child:________________________________________
 
Name of Parent or Legal Guardian :______________________________________________ Payment Enclosed: $__________ Check/Cash