Parent/Caregiver * First Name Last Name Child's Name * First Name Last Name Child's DOB * MM DD YYYY Age and Grade * Email * Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Which program(s) are you enrolling in? * Music Play (babies, toddlers, preK) Piano Pathway MamaSong - prenatal music for mothers-to-be About My Child * Include musical goals, musical background, preferred learning environments, behavioral supports, special needs, and any other information you would like to share in order to help me support your child Emergency and Health Information * Emergency Contact Name & Phone, Allergies How did you hear about us? Include referrals Is there anything you would like to ask or share? Participation & Liability Waiver and Media Consent * Your family’s safety and comfort are our top priorities. Music learning involves joyful movement, instrument play, and group activities. While we take every step to create a safe environment, we do ask families to review and agree to our participation agreement so everyone understands expectations. Thank you for helping us create a safe and joyful music community! I understand that participation in Music Play, Piano Pathway, and MamaSong involves normal physical and group activity risks. I release Song’s Keys Music Studio and its staff from liability for injuries or illnesses except in cases of gross negligence. I confirm that my child(ren) are healthy enough to participate and that I am responsible for their supervision unless otherwise stated in the program description. I also understand that all classes may be recorded and shared only with enrolled families for educational purposes, and that these recordings may not be copied, shared, or distributed outside of the program. I give permission for photos/videos of my child to be used for program materials or social media. REGISTRATION FORM 2025-26
