This Form cannot be submitted until the missing
fields (labelled below in red) have been filled in
OPMI Mommy Baby Registration Form
Please note that all fields followed by an asterisk must be filled in.
Parent/Guardian First Name*
Parent/Guardian Last Name*
E-Mail Address*
Street Address*
Home Phone*
Child's Full Name*
Age*
---Select---
0
1
2
3
4
Child's OMBA Classroom Teacher's Name
Has your child even been in any of our MusicFirst Classes before?
YES
NO
Class Choice -$65.00/Session (6 weeks)*
---Select---
Stage 3: PRESCHOOL (Age 3-4) - Mondays 4:15-5:00pm
Semester Start Date (MM/DD/YYYY)
Session Fee Total*
OPMI Music First Payment Responsibility*
BY CHECKING THIS BOX, I understand that semester tuition fees are due at the beginning of the semester and are NON-REFUNDABLE. I am responsible for payment in full. I understand that class is once per week. I acknowledge that there will not be a pro-rated rate or refund for any portion of the 6-week semester that my child and I do not attend.
Photo Release
Yes, I authorize OPMI to take photos of my child to share with class parents and use for OPMI related promotional purposes
No, I do not authorize OPMI to take pictures of my child to share with parents and use for OPMI related promotional purposes
OPMI Music First Liability Waiver*
BY CHECKING THIS BOX, I AGREE THAT I HAVE READ AND VOLUNTARILY SIGN THIS AGREEMENT ELECTRONICALLY and further agree that no oral representation, statements, or inducement apart from the following written agreement have been made: IN CONSIDERATION, of being permitted to utilize the facilities, services and programs of ORLANDO PREMIER MUSIC INSTRUCTION, hereinafter referred to as “OPMI”, for any purpose, including, but not limited to observation or use of facilities or equipment, or participation in any off-site program affiliated with OPMI, the undersigned, for himself or herself and any personal representatives, heirs, children and next of kin, hereby acknowledges, agrees and represents that he or she releases OPMI and its staff members from all liability for any injury, loss or damage connected in any way whatsoever to participation in OPMI activities whether on or off of the premises affiliated with OPMI. He or she understands that this release included any claims based on negligenc
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