Consent form

Childs name *

First

Last

preferred name/ nickname

Birthday *

Elementary School *

Emergancy contact name *

First

Last

Emergancy contact phone

Please include names and phone numbers of others authorized to pickup your child.

Please describe any pertinent allergies. We serve a snack of dairy free organic popcorn, baby carrots, hummus, oranges and bananas. We also have a few studio cats but they usually stay upstairs and out of the way.

Tell us about your kiddo: Favorite song? Left or right handed, ambidextrous? Needs, expectations, concerns? Prior musical experience/ interests? Favorite animal? Number of siblings? Unique qualities? Struggles and transitions? School they attend? Anything you'd like to share is great!

BILLING AGREEMENT: Please select one of the following options. **A convenience fee of %3.5 will be added to invoices payed with a credit card. *

Charge my card on file today for the full amount.
Charge my card on file today for 1/2 the amount and charge the other 1/2 at the end of the last week my child will be attending.
I will pay with check or cash (in full) at the beginning of each week that my child is attending.
I will pay with check or cash 1/2 the amount at the beginning and 1/2 at the ending of each week that my child is attending.
I would like my card on file to be billed (in full) at the beginning of each week that my child is attending.
I would like my card on file to be billed 1/2 the amount at the beginning and 1/2 at the ending of each week that my child is attending
Not sure yet. I'll let you know later.
Other (please describe below)

Please provide primary account holder's name and email address (one more time) *

First

Last

email address (one more time) *

Please include your custom billing options or questions below

ATTENDANCE POLICY: If my child misses a practice I understand I will still be billed according to our billing agreement; however, I also know that my child can makeup a missed practice any other day of that week or the following weeks as many times as they need per week. *

I agree.
I would like more information.

PHOTO/VIDEO/AUDIO RELEASE: I give permission and consent to Skunk Rock to make, reproduce, and edit video film, footage, sound track recordings and photo reproductions of my child for legitimate business uses. Skunk Rock may take photos and video of my child. These may be used at Skunk Rock websites, parent and community materials, and social media posts. *

I agree.
I would like more information.

How did you hear about us? *

Are you signing up another child today? *

Yes
No

This is the last form you’ll have to fill out! We just need a little more information about you and your kiddo.