Mommy & Me Class Enrollment Form

Sign up for lessons at Panharmonic Music Studio. Lessons times are honored on a first come, first serve basis.

Student's Name *
Student's Name
Date of Birth *
Date of Birth
Student 2's Name
Student 2's Name
Date of Birth
Date of Birth
Student 3's Name
Student 3's Name
Date of Birth
Date of Birth
Address *
Address
Parent's Name *
Parent's Name
Parent's Phone Number *
Parent's Phone Number
Legal Release *
I, the undersigned, do hereby grant permission to Panharmonic Music Studio (aka, “The Studio") to post my and/or my child’s story, photo, or other items, hereinafter referred to as “Materials,” to be used in social media (e.g., Facebook and/or Instagram) and/or other promotional material for The Studio.

I acknowledge and agree that no sums whatsoever will be due to me as a result of the use and/or exploitation of the “Materials” or any rights therein.

I acknowledge that my child is under 18 years old and lacks the legal capacity to enter into binding agreements. Accordingly, I have read this Release and consent to my child’s inclusion in the Materials will not contest the rights granted in this Release, and shall assist and support you in any and all legal proceeding for affirmation of this Agreement, should you choose to have a court of law affirm this Agreement.
Student or Parent/Guardian Electronic Signature *
Student or Parent/Guardian Electronic Signature
Parent/Guardian's Birthday *
Parent/Guardian's Birthday
This confirms that you are over 18 and the actual parent/guardian.