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Music Academy Registration Test
Music Academy at Pulaski Heights UMC Registration Summer 2025
Parent/Guardian Name
(Required)
First
Last
Parent/Guardian Email
(Required)
Parent/Guardian Phone Number
(Required)
Student 1
Student Name
(Required)
First
Last
Student Age
(Required)
Please select your current instructor
(Required)
Sungyun Kim
Joanna Klett
Siewlee Lim
Sandy McDonald
Marian Payne
Joann Richmond
Lesson Duration
(Required)
Please select either 30, 45, or 60 minute lessons. Lessons are $1 per minute.
30 Minutes
45 Minutes
60 Minutes
Number of Lessons
(Required)
Lessons are offered the following weeks: June 2, June 9, June 16, June 23, July 7, July 14, July 21, July 28. Please list the total number of lessons you’d like to take.
Please enter a number from
1
to
8
.
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Section Break
Supervision Waiver
(Required)
I have read, understand, and agree with the statement below.
I hereby acknowledge and give my permission for my child(ren) to participate in individual or small group lessons conducted by Pulaski Heights United Methodist Church Music Academy (Adventures in the Arts). I understand that the lessons will consist of one or more children or youth and only one adult leader. I further understand that these lessons and rehearsals will be conducted in rooms located in Pulaski Heights United Methodist Church (‘PHUMC”) and that the doors might be closed during these times. I understand that I have the right to be present in the room while my child(ren) is(are) having a lesson. If I choose not to be present in the room during a lesson, I agree that such a decision will be treated as my own and made with the understanding that I do have the right to be present. I further understand that my child is not allowed to wander through the church unsupervised regardless of whether they are in a lesson. With the exception of the room where my child participates in a lesson, access to all other PHUMC facilities is prohibited. Under no circumstances will the church be used as a playroom for unattended children. PHUMC Music Academy cannot provide supervision for children left alone before or after lessons. Except as stated below regarding students with a valid driver’s license, all students must be directly supervised immediately before and after their lessons unless other arrangements have been made in a writing signed by Dr. Frode Gundersen, who has sole discretion on whether to allow such other arrangements.
Liability Waiver
(Required)
I have read, understand, and agree with the statement below.
In consideration for my child’s participation in PHUMC Music Academy (Adventures in the Arts), I agree to:
1. Assume all risk to me and/or my child, and all risk of damage or loss of property directly arising out of my own or my child’s participation in activities.
2. Release, discharge and waive any and all responsibility of PHUMC Music Academy and/or PHUMC employees, agents, representatives and volunteers from and against liability for any injury including death and for damage to or loss of property which may be suffered by my child or myself directly arising out of, or in any way connected with participation in PHUMC Music Academy.
3. Except in a case of gross negligence, indemnify and hold harmless all PHUMC Music Academy or PHUMC personnel from and against all liability, claims, demands, actions, loss and damage directly arising out of my participation or my child’s participation in PHUMC Music Academy.
4. I have read this agreement, fully understand its terms, and understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing the agreement freely and voluntarily and intend by my signature below to be a complete and unconditional release of all liability to the greatest extent of the law.
Total
Credit Card
Cardholder Name
Card Details
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