Name: *

First Name

Last Name

Date of Birth: *

MM

DD

YYYY

Phone Number: *

(###)

###

####

Home Address: *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian Name: *

First Name

Last Name

Parent/Guardian Work Phone Number:

(###)

###

####

Parent/Guardian Cell Phone Number: *

(###)

###

####

Parent/Guardian Home Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian address is the same.

How would you describe your music experience? *

This is my first time writing and performing songs.

I am a mid-level single/rapper/musician.

I am very advanced at rapping, singing, musicianship and performing.

Is the participant currently being treated for an injury or sickness, or taking any medications? *

No

Yes

Is the participant allergic to any foods or medications? *

No

Yes

Does the participant require a special diet? *

No

Yes

Free/Reduced lunch at school?

Check this box if the participant qualifies for free or reduced lunches at school.

How did you hear about The Bridge?

After-School Program

School

Website

Social Media

Word of Mouth

Flyer

Other

Media Release: Youth Agreement *

By checking this box, I, the Youth Participant, understand that photos, video and audio recordings of me can be used on The Bridge Music Project’s website, social media pages, and for other promotional purposes.

Media Release: Guardian Agreement *

*Have your guardian review this statement and agree by checking the box.

By checking this box, I, The Guardian, understand that photos, video and audio recordings of my youth can be used on The Bridge Music Project’s website, social media pages, and for other promotional purposes.

The Bridge Music Project Liability Waiver: *

I understand and acknowledge that there is no guarantee that this activity is free of risk of personal injury or property damage or loss. I agree to abide by all applicable Bridge Music Project policies and understand that The Bridge Music Project and/or the class facilitator has the right to exclude me from the class if I become disruptive to an extent that is a detriment to the enjoyment and trust of the other participants and facilitators. I understand and acknowledge that in order to participate in this class, I agree to assume all liability and responsibility for any and all potential risks, injuries, or even death that may be associated with my participation in this class. I understand, acknowledge, and agree that The Bridge Music Project, its owner, employees, and volunteers, guest speakers, any assistants to the instructor, or any representatives of the above, shall not be liable for any injury, illness, damage to or loss of property suffered by me which is incident to and/or associated with my participation with The Bridge Music Project. I hereby release, discharge, indemnify, and agree to hold harmless all parties mentioned above free from any and all liability arising out of or in connection with my participation in this class and/or closing performance. For purpose of this Waiver, liability means all claims, demands, losses, causes of action, suits, or judgments of any kind that may originate from any guardians, heirs, executors, administrators, and assigns against all parties mentioned above because of my personal, physical, or emotional injury, accident, illness, or death, or because of any loss or damage to property that occurs to me or my property during my participation that may result from any cause including but not limited to all parties mentioned above own passive or active negligence or other acts from fraud, willful misconduct, or violation of the law.

I hereby agree to the terms of this Waiver of Liability. This waiver is in force for the entire duration of the class and whenever I am on property used by The Bridge Music Project, both interior and exterior.