Student Name *

First Name

Last Name

Student Birth Date *

MM

DD

YYYY

Student Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent Name *

First Name

Last Name

Parent Phone *

(###)

###

####

Name of Emergency Contact *

First Name

Last Name

Phone of Emergency Contact *

(###)

###

####

Instrument *

Violin

Viola

Cello

Bass

Piano

Private Instructor (if not applicable write NA in both fields) *

First Name

Last Name

Name of Referrer (if applicable)

First Name

Last Name

Adult T-shirt Size *

S

M

L

XL

XXL

I have read and agree to the terms of the conduct policy. *

Nothing indecent, disruptive, or illegal will be tolerated at Leopold Auer Music Festival. This includes any form of bullying or harassment. Any student not abiding by this policy is subject to immediate removal from Leopold Auer Music Festival without refund.

Yes

No

I have read and agree to the terms of the hold harmless policy. *

I release and absolve Leopold Auer Music Festival from any claims pertaining to personal injury, death, and lost or damaged property. I authorize the employees and agents of Leopold Auer Music Festival to obtain medical care in the event of an emergency, including transportation by ambulance. I understand Leopold Auer Music Festival cannot guarantee a risk-free environment, and I indemnify Leopold Auer Music Festival for the costs of medical care or other damages incurred from participation in Leopold Auer Music Festival programming.

Yes

No

I have read and agree to the communication policy. *

Leopold Auer Music Festival reserves the right to audio record, video record, and photograph activities for printed or electronic materials, radio, television, and online broadcast. I understand Leopold Auer Music Festival may use student and parent likenesses online, in print, and in audio and video recordings for any purpose without remuneration.

Yes

No

I have read and agree to the carpool policy. *

I assume all risks and waive all rights of liability forever against Leopold Auer Music Festival, with respect to actions, claims, or demands arising out of connection with any carpool arrangement affiliated with or related to Leopold Auer Music Festival, regardless of whether such claim, demand, or action is the result of the negligence of carpool participants or otherwise. I understand Leopold Auer Music Festival does not check drivers’ license validity, verify insurance coverage, or run background checks for carpool participants.

Yes

No

I have read and agree to the lost, stolen, and damaged goods policy. *

Leopold Auer Music Festival is not responsible for any lost, stolen, or damaged items or goods taking place on festival property or during any festival programming or transportation to or from Leopold Auer Music Festival programming. I release Leopold Auer Music Festival from all liability from any claims resulting from any lost, stolen, or damaged items or goods during the entire participation of Leopold Auer Music Festival and its entire programming and transportation to or from programming.

Yes

No