Music Mentorship Participant Application

*must be between the ages of 14-21.

 *This project is a partnership with the City of Olympia Parks, Arts, and Recreation Department. By filling out this application you will also be registered in their database.  


Overview:
This spring The Bridge is starting a new mentorship program in partnership with The City of Olympia. This project is about teaching youth music skills, while also connecting them with positive adults to act as role models.  


Format:

  • Each week music mentors will meet with youth at the Capitol Theater/ Bridge headquarters for a 90 minute mentoring session.

  • Youth will be matched with their mentors based on their personalities and creative interest.

  • The priority in this project is fun. While we want youth to improve as musicians, this is meant to be a low-pressure environment.


Location:

Bridge Headquarters at The Capitol Theater

206 5th Ave E, Olympia WA 98501


Dates:

  • Wednesday, May 8th 5:30pm to 7pm

  • Wednesday, May 15th 5:30pm to 7pm

  • Thursday, May 23rd 5:30pm to 7pm

  • Thursday, May 30th 5:30pm to 7pm

  • Wednesday, June 5th 5:30pm to 7pm

  • Wednesday, June 12th 5:30pm to 7pm

  • Wednesday, June 19th 5:30pm to 7pm

  • Wednesday, June 26th 5:30pm to 7pm


Acknowledgement of Review of Workshop Summary *
Name: *
Name:
Date of Birth: *
Date of Birth:
Phone Number: *
Phone Number:
Home Address: *
Home Address:
Select one.
Parent/Guardian Name: *
Parent/Guardian Name:
Parent/Guardian Work Phone Number:
Parent/Guardian Work Phone Number:
Parent/Guardian Cell Phone Number: *
Parent/Guardian Cell Phone Number:
Parent/Guardian Home Address:
Parent/Guardian Home Address:
What music experience have you had in the past? *
Is the participant currently being treated for an injury or sickness, or taking any medications? *
Is the participant allergic to any foods or medications? *
Does the participant require a special diet? *
Free/Reduced lunch at school?
How did you hear about The Bridge?
Demographic Information
*The following information is kept private and used for Bridge data purposes only.
Please enter any race/ethnicity that you identify with. List as many as you like. If you prefer not to answer this question, please write "Decline to answer".
Media Release: Youth Agreement *
Media Release: Guardian Agreement *
*Have your guardian review this statement and agree by checking the box.
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 ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS RELEASE OF LIABILITY. I UNDERSTAND THE POTENTIAL DANGERS AND AM WAIVING CERTAIN RIGHTS AND ASSUMING THE RISK OF DAMAGE FROM MY PARTICIPATION.