Health & Safety Agreement

Student's Name*

First Last

Age*

Musical Experience (years of lessons)

Parent or Guardian Name*

First Last

Relationship*

Home Phone

Cell Phone*

Email*

Address*

Street Address City State ZIP Code

AGREEMENT*

I give my permission for my child to participate in music lessons at the Jupiter Academy of Music. I understand that the very best possible care and attention will be given to my child’s health, welfare and safety while at Jupiter Academy of Music. I understand that strict protocols are in place to make the physical environment as germ-free as possible. I absolve the teachers and Jupiter Academy of Music, LLC. of any responsibility for the health and welfare of my child.

Signature of parent/guardian*

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Name

First Last

(Person responsible for payment)

Email

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