Please fill out this form for the student and for everyone (parents, siblings, sitters, etc) who will be coming to lessons with the students.  


Release and Indemnity Agreement: I understand that participating in music lessons can involve risk of injury: these risks include inclement weather, accidents while traveling, equipment problems or failures, contacts with actions of other participants, slips/trips/falls, and musculoskeletal injuries, among others. I choose for myself or for my child to participate in the music lessons despite the risks. By signing this form, I acknowledge all risks of injury, illness and death and affirm that I have assumed all responsibility of injury, illness or death in any way connected with participation in the music lessons. I also agree for myself and for any child participant to follow all rules and procedures for the music lessons and to follow reasonable instructions of the teacher and supervisors of the program. In return for the opportunity to participate in these music lessons, I agree for myself and for my heirs, assigns, executors and administrators to release, acquit, waive and forever discharge any legal rights I may have to seek payment or relief of any kind from the teacher, Eve Hubbard and the City of Greensboro, its officers, employees, agents or its volunteers for injury, illness, death or property loss resulting from this program. If I am registering a child for music lessons, I agree that I am a parent, legal guardian, or am otherwise responsible for the child whose application I am submitting and that I release, waive, and discharge any legal rights that I may request on behalf of the child participant in the program. I also agree not to sue Eve Hubbard, the City, its officers, employees or agents and agree to indemnify the City for all claims, damages, losses, or expenses, including attorney’s fees, if a suit is filed concerning an injury, illness or death to me or my child resulting from participation in the music lessons. Permission is given for any emergency medical treatment which might become necessary and I agree to be responsible for the expense of medical treatment or service.

Name of all who will be attending lessons: ____________________________________________________________________________

Signature of student (if above 18 years old) or parent/guardian: _____________________________________________________

Date: ______________________________________________


Image Release: I, the undersigned, hereby consent to allow the exclusive use of, and relinquish all rights to, photographs, recordings and reproductions in any manner (including but not limited to the use of photos, video and audiotapes) of the likeness, voice, and/or activities of the participant and further authorize the Eve Hubbard, its agents or assigns, to make unlimited use of such reproductions, including but not limited to print and/or electronically, broadcasting of the reproduction over radio, television, and on the internet with or without your name for any lawful purpose. I acknowledge that no compensation will be provided for such use by the City. I understand that this Release shall remain in effect unless a subsequent written notification is provided to the City.

Name of Student: ______________________________________________________

SIgnature of student (if above 18 years old)
or parent/guardian: _____________________________________________________

Date: ______________________________________________