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This waiver is required for all students taking in person lessons/classes/camps/etc at Cal Heights Music.

Thank you

 

 

 

First Participants Name

First Name*

Middle Name

Last Name*

Phone*
First Participants Date of Birth*
First Participants Information

Instrument *
First Participants Signature*
Second Participants Name

First Name*

Middle Name

Last Name*
Second Participants Date of Birth*
Second Participants Information

Instrument *
Third Participants Name

First Name*

Middle Name

Last Name*
Third Participants Date of Birth*
Third Participants Information

Instrument *
Fourth Participants Name

First Name*

Middle Name

Last Name*
Fourth Participants Date of Birth*
Fourth Participants Information

Instrument *
Fifth Participants Name

First Name*

Middle Name

Last Name*
Fifth Participants Date of Birth*
Fifth Participants Information

Instrument *
Sixth Participants Name

First Name*

Middle Name

Last Name*
Sixth Participants Date of Birth*
Sixth Participants Information

Instrument *
Seventh Participants Name

First Name*

Middle Name

Last Name*
Seventh Participants Date of Birth*
Seventh Participants Information

Instrument *
Eighth Participants Name

First Name*

Middle Name

Last Name*
Eighth Participants Date of Birth*
Eighth Participants Information

Instrument *
Ninth Participants Name

First Name*

Middle Name

Last Name*
Ninth Participants Date of Birth*
Ninth Participants Information

Instrument *
Tenth Participants Name

First Name*

Middle Name

Last Name*
Tenth Participants Date of Birth*
Tenth Participants Information

Instrument *
Parent or Guardian's Email Address

Email*

Confirm Email*
COVID-19 Guidelines
* I am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell. And I will not come to Cal Heights Music if I am experiencing these symptoms. *
I agree
* I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19. I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non contagious by state or local public health authorities. *
I agree
* I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19. *
I agree
I understand that face masks are not required (per state and city guidelines) but Cal Heights Music strongly recommends wearing one. If things change with the guidelines set forth by the city please understand masks may be required again. *
I agree
I understand that Cal Heights Music offers all their lessons, classes, camps, and other services online. It is my choice to come to Cal Heights Music in person. *
I agree
I understand that I will cancel my lesson at Cal Heights Music by calling or emailing if I am sick, if someone in my household is sick, or I have been exposed to anyone diagnosed with Covid 19. If I cancel a lesson due to possible exposure to Covid 19, but am otherwise healthy, my lesson will be automatically converted to an online lesson via Zoom or FaceTime and will take place at the same day and time. *
I agree
I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing. I further acknowledge that Cal Heights Music has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19. I further acknowledge that Cal Heights Music can not guarantee that my family or I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, staff, students, and their families. I voluntarily choose lessons in person at Cal Heights Music and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while at Cal Heights Music. I hereby release and agree to hold Cal Heights Music harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of Cal Heights Music, or that may otherwise arise in any way in connection with any services at Cal Heights Music. I understand that this release discharges Cal Heights Music from any liability or claim that I, my heirs, or any personal representatives may have against Cal Heights Music with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to Cal Heights Music. This liability waiver and release extends to Cal Heights Music together with all owners, partners, and employees. *
I agree
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Instrument *
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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