Mesa Community College United Sound Registration
All the information you provide on this application is private and will only be used in connection with your United Sound experience. Only authorized users will have access to this information. United Sound never shares your information with anyone else.
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Select: *
Participant First and Last Name *
Age *
Select *
Instrument *
Participant Email Address *
Participant Phone Number *
Address *
Emergency Contact Name *
Emergency Contact Phone Number *
T-Shirt Size *
Media Release *
I hereby grant United Sound, Inc. permission to use the video, photographic, and/or audio representation of the above named minor for use in media releases, publications, and Web site(s). I also grant permission for interviews and/or photographs by the media. I understand and agree that participation in the activity will include video and/or audio recording or photographs, and that the program(s) in which the student participates will be identified with United Sound. I consent to the student’s participation and/or interview with this understanding. *
Required
Liability Release *
In consideration of the benefits and opportunities afforded to me through participation in the United Sound organization, the undersigned participant states as follows: 1. I hereby agree to release United Sound, Inc., from any liability for any accident, injury, or illness suffered at, during, or in connection with any United sound activity. 2. I understand that the teachers who charter individual United Sound clubs are not employees or staff of United Sound. They are employees of the school district with which they are employed and are responsible only to that entity. 3. I understand that, in connection with any United Sound activity, if I am riding in a private passenger automobile which is involved in an accident, I may be primarily covered for bodily injury under my family automobile policy, and I agree to submit any medical bills incurred to my insurance company for payment. If my policy has been issued with a deductible clause relative to the personal injury protection, I understand that I have assumed that deductible on primary coverage. 4. If I am being transported in a commercial carrier or other leased or rented vehicles in connection with a United Sound activity and an injury occurs, I understand that I shall look to the commercial carrier or owner of the leased or rented vehicle to pay any medical bills incurred as a result of such injury. NOTE: The undersigned agrees to assume all risk of accident, injury, or illness that may occur at, during, or in connection with any United Sound activity. *
Required
Participant Agreement *
I understand that I am making a year-long commitment to the music program that I am joining. I will give my best effort to be present at all club meetings and performances. *
Required
Date *
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