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*

Sign form using touchscreen device, touch pad or mouse.

Name

First Last

(Person responsible for payment)

Name

This field is for validation purposes and should be left unchanged.

Get In Touch!

About Us