TMI at HCC Consent Form | Howard Community College

The Music Institute at HCC 2018- 2019 Consent Form

Student/Parent email address*

CLASSES & ENSEMBLES

If YES, select

Fall

Spring

Summer

TEACHERS

Teacher Email Address:

Teacher's email address - enter the email address found next to the instructors name displayed above.*

LESSONS

Are you registering for private lessons?*

Yes

No

If yes, length of Lessons:

Numerical section(s) for which you are registering (check all that apply): PLEASE NOTE: NEW STUDENTS should only register for 1 section as a trial period, and that RETURNING STUDENTS may sign up for multiple sections per their pre-agreed discussion with their teacher. CHOOSING A TERM IS REQUIRED.

Term 2018A2

9 - September

10 - October

11 - November

12 - December

Term 2019A2

7 - July

8 - August

Media Permission (Please check the appropriate box)

My child does NOT have my permission to be photographed, interviewed, audiotaped, or videotaped while attending lessons, rehearsals, classes or recitals for possible use in marketing including Facebook and YouTube.

My child has my permission to be photographed, interviewed, audiotaped, or videotaped while attending lessons, rehearsals, classes, or recitals for possible use in marketing including Facebook and YouTube.

Waiver of Responsibility

Please check this box to indicate agreement to the waiver of responsibility statement below.*

I/We understand and voluntarily assume all risks inherent in the nature of this activity and I/we waive and release all claims, costs, liabilities, expenses and judgments against HCC and its representatives arising out of my participation or my child’s participation in the activity at The Music Institute. HCC and The Music Institute are not responsible for personal items brought or left on campus. DO NOT BRING: Games, toys, trading cards, electronic devices unless expressly required by the instructor for the class, lesson, or rehearsal. All cell phones must be turned off during class hours. HCC is not responsible for lost, broken, or missing personal items or instruments.

Responsible Party Signature (may not be a minor). In order for the student to be officially registered this form must be signed and dated.

I certify that I am registering myself or my minor child for lessons, ensembles, or classes at The Music Institute and that the information presented herein is correct to the best of my knowledge. I understand that it is my responsibility to notify The Office of Records, Registration & Veterans’ Affairs and The Music Institute Office of any change in the information contained in this application. I will take financial responsibility for the tuition and fees due to HCC.

Responsible Party’s Name (Please Type Your Name Here)*

All charges due to Howard Community College (HCC) must be paid in full by the published payment due date. Past due balances are subject to collection and fees up to 25% of the original balance. Students whose accounts are delinquent will not be permitted to register for the next term or receive official transcripts and diplomas. HCC may require payment in the form of
certified funds, such as cash, money order, credit card, or cashier’s check.

Responsible Party’s Address (If different from the student’s address listed on the Student Information Sheet)

Responsible Party’s Signature (Please type your full name here.)*

Date*