Chamber Music Ensembles Registration Form

Registration Information

Who are you registering? *

Payment Options *

Would you like to receive information on scholarships? *

Student Information

First and Last Name *

Preferred Name

Gender *

Female

Male

Not Available

Birthdate *

Year

Month

Day

Home Address *

City *

State *

Zip Code *

Email Address *

Billing and program information will be sent to this email address.

Verify Email Address *

Phone Number *

Home

Cell

Home or cell *

Name of School (2023-24 academic school year) *

Grade (2023-24 academic year) *

Instrument *

Do you study with a private teacher? *

Private Teacher Name *

Private Teacher Email *

Parent/Guardian Information

First and Last Name *

Home Address *

City *

State *

Zip Code *

Email Address *

Verify Email Address *

Phone Number *

Format ex. 9205551212

Home

Cell

Home or cell *

Parent/Guardian 2 Information (optional)

First and Last Name

Is the home address the same as the parent/guardian above?

Home Address

City

State

Zip Code

Email Address

Verify Email Address

Phone Number

Format ex. 9205551212

Home

Cell

Home or cell

Availability

Class days and times will be determined once registration is complete. Groups will be made by age and playing level.

Comments

Students I would like to be grouped with (optional)

This is not guaranteed. Group placements are determined by the Chamber Ensembles coordinator.

Repertoire Information

Most Current Solo Piece *

If you haven't performed a solo piece, please list the most current school/community orchestra piece(s) you performed.

Past Chamber Ensemble Experience *

Community Guidelines

Registration in a Community Music School program indicates understanding and acceptance of our guidelines.

Acknowledgement *

By checking this box, I agree to follow all the Community Music School guidelines and accept responsibility for all charges and fees that are incurred.

Assumption of Risk and Release of Liability

This document affects your legal rights - read it carefully.

I am registering for a Program of the Lawrence Community Music School during the program year, July 2023-June 2024. I acknowledge that the Program is voluntary and may involve certain risks, including those described below.

I understand that the Program involves, among other activities, rehearsing, performing, engaging in recreation, and, if applicable, traveling off campus. I acknowledge that these activities present certain inherent risks beyond Lawrence University’s control.

I choose to participate in the Program understanding its associated risks, and I knowingly and voluntarily assume all risks of injury, illness, death, or damage to or loss of my property that may occur while rehearsing, performing, traveling, engaging in recreation, or any activities arising out of or related to the Program.

My participation in the Program is voluntary, and I understand that I may discontinue my participation at any time in light of the risks I am assuming.

I hereby forever release Lawrence University, its trustees, officers, employees, and agents (the “Released Parties”), from liability for any negligent act or omission arising from my participation in the Program, including related costs, damages, claims, or assertions to which I or my family, estate, or heirs may claim against the Released Parties.

This Assumption of Risk and Release of Liability shall be construed in accordance with the laws of the State of Wisconsin, which shall be the forum for any lawsuits filed under or incident to this Release or the Program.

Acknowledgement *

By checking this box I agree to the Assumption of Risk and Release of Liability.

How did you hear about the Lawrence Community Music School? *

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