International Voice Seminar Registration 2012	Date:

Name:	M F DOB:

Parent Contact (if a minor):

Street:	City:

State:	Zip:	Home phone:	Cell:

Email:

Emerg. Contact:	phone:

Vocal Range (if known):	Register (head, chest, mixed, belt):

Vocal Training:

Desired outcome for this workshop?

Do you need help with accommodations?

Workshop Schedule:

Friday, July 13: 9:00-5:00 instruction; and optional faculty concert from 7:00-9:00

Saturday, July 14: 9:00-5:00 instruction; and student showcase from 7:00-9:00

Sunday, July 15: 9:00-5:00 instruction.

Tuition: $195 per week if received before May 15th, or $245 per week after May 15th.

[For office: Amount paid:	Date:	Check #:	CC:	]

317 Main may photograph, record, and/or videotape classes, lessons and/or events sponsored by

317 Main for educational purposes and/or use on 317 Main online and social media and publication

materials. If you do not wish your camper to be photographed, recorded, and/or videotaped, please submit a brief written statement and submit it to the front desk.

I have read the Policies and Procedures and agree to 317 Main Street’s payment procedures and cancellation policy.

Signature:	Date:

I, __________________________, am the parent or legal guardian of ____________________________, who is enrolling in classes, lessons and/or

other related activities with 317 Main Street, Inc. — OR —

I, ___________________________, am

enrolling in classes, lessons and/or other

related activities with 317 Main Street, Inc.

I, ______________________________, hereby consent and agree, for myself and/or my minor child, to participate in classes, lessons, rehearsals, performances and/or other related activities with 317 Main St., Inc. I understand that certain of these activities may require physical exertion and acknowledge that participation in these activities can carry with it a risk of personal injury to me or to my child.

I understand that I am fully responsible for myself and/or my child until such time that my/his/her class, lesson, or other 317 Main St. Community Music Center activity begins, and that I also am responsible for myself and/or my child immediately upon the conclusion of

my/his/her activity at the Center. This

includes, but is not limited to, transportation to and from the Center, and all time spent at the Center (including the lobby area, café, outside

garden and/or reception area) waiting for the scheduled activity to begin and/or waiting for pick-up following an activity.

In consideration for 317 Main St., Inc. accepting me/my child into its program, I do hereby for myself, my spouse, my children, our heirs, personal represen-tatives and assigns, expressly release and forever discharge 317 Main St., Inc. its officers agents, and employees of and

from any liability and all claims, suits or causes of action arising from or as a

result of my/my child’s participation in 317 Main St., Inc. Community Music

Center programs, including, without

limitation, injuries or damages sustained by myself and/or child on property managed by 317 Main St., Inc./Slade Hill LLC. In addition, I hereby give my consent for 317 Main St., Inc. to seek necessary emergency medical treatment for me/my child, and for me/my child to receive such emergency medical treatment, which may be deemed necessary or advisable in the event of injury, accident or illness. I accept financial responsibility for all such medical treatment that may be provided. By signing below, I acknowledge that I understand and agree to all guidelines and conditions set forth above.

_________________________________

Participant Name – please print

_________________________________

Participant Signature

_________________________________

Date

_________________________________

Minor Participant Name – please print

_________________________________

Parent/Guardian Name - please print

_________________________________

Parent/Guardian Signature

_________________________________

Date Signed

I acknowledge that I have read and

understand 317 Main’s cancellation and payment policies as put forth in the Policies and Procedures.

_________________________________

Participant/Parent/Guardian Signature

_________________________________

Date Signed

317 MAIN STREET RELEASE & WAIVER FORM

317 Main St., Yarmouth, Maine 04096 ( 207-846-9559 ( www.317mainst.org

2/9/12

Date:

Jason Phelps

2012-02-16

Front Desk

317 Main St.