SBW_2020_Registrations

SBW After School Registration Form

Please note that all fields followed by an asterisk must be filled in.

First Name*

Last Name*

E-Mail Address*

Street Address*

City*

Cell Phone*

Student's Name*

Age*

Music Class *

Are you signing up siblings?*

If you are signing up siblings, how many children in total will participate?*

Please list siblings names and ages*

Where will your student go after their music class?*

Additional Authorized Child Pick Up (Please list names, phone numbers, and relation to the child)*

Do you authorize OPMI to use photos of your child on our website and/or promotional material?*

OPMI Payment Policy*

I understand that LEGO and DRAWING classes are broken into 6 classes per session and is to be paid in full for all 6 classes, I understand registration and tuition payments are non-refundable; OPMI does not prorate tuition fees due to student start date. Refunds will only be issued if a class is cancelled entirely due to low enrollment or other unforeseeable circumstances. Refunds will be issued via U.S. Mail. Refunds and/or tuition adjustments are not issued due to lack of attendance or missed classes.

OPMI Liability Waiver*

BY CHECKING THIS BOX, I AGREE THAT I HAVE READ AND VOLUNTARILY SIGNED THIS AGREEMENT ELECTRONICALLY and further agree that no oral representation, statements, or inducement apart from the following written agreement has been made: IN CONSIDERATION, of being permitted to utilize the facilities, services and program of ORLANDO PREMIER MUSIC INSTRUCTION, herein after 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 an 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 includes any claims based on negligenc

Special Requests/Needs/Concerns: