Rochester Contemporary School of Music - Trumpet Clinic RSVP

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Section I - Basic Info
Student's Name *
Student's Name
Section II - Parent/Guardian
Parent/Guardian *
Parent/Guardian
Phone *
Phone
Alternate Phone
Alternate Phone
Emergency Contact *
Emergency Contact
Emergency Contact Phone *
Emergency Contact Phone
Additional Info
Have you, at any time, taken private lessons on outside of school? *
Have ever been diagnosed, or considered for diagnosis, for any disabilities (i.e. learning, social, physical, emotional, etc.) *
*This helps us better serve you!
Final
Image & Audio Release *
Occasionally, professional photographers, videographers, and/or audio engineers will visit private lessons, classes and/or performances for us to maintain an up-to-date photo, video, and audio library for use in Rochester Contemporary School of Music publications, videos, social media, and website. If you, or your child, have an expressed objection to having your image included in photo, video, and/or audio publications, please advise us PRIOR to your first lesson or class. Otherwise, Rochester Contemporary School of Music reserves the right to select, print, and/or publish all images and audio recordings that are representative of our programs. (*NOTE: Rochester Contemporary School of Music will never print names of students without additional prior consent) I have read and accept RCSM's Image & Audio Release