Parent or Guardian's Name
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First Name
Last Name
Student's Name
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First Name
Last Name
Student's Birthday
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School/Summer Camp Child Attends
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Does your child have any special needs, learning styles, etc. we should know about?
USE THIS SECTION TO REGISTER A SIBLING (otherwise leave it blank):
First Name
Last Name
Student's Birthday
First Name
Last Name
Birthday of above student
Does your child have any special needs/learning styles that we should know about?
Parent's Email Address
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Summer Address
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Emergency Contact Name and Number
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For any last-minute scheduling issues, who do we contact? (Examples: mom, dad, sitter, personal assistant)
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Phone Number for Above Contact:
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Summer lessons in the Hamptons (and Long Island) are $50 more per lesson than lessons in NYC (Please note: your teacher will be traveling from NYC).
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I understand.
Payment is due at the beginning of the semester.
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I understand that I am required to pay for the semester of lessons in advance.
There are NO makeups or refunds allowed during the summer session. Your instructor will be traveling from the city for your child's lessons and has very limited time slots available. Note: if your teacher has to miss a lesson, you will be given a makeup option or a credit towards future lessons with Blue Balloon if a makeup isn't possible.
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I understand there are no makeups or refunds for summer lessons.
I understand that all payment is done through the main office. I understand that I am not to pay teachers directly.
I understand that I pay my instructor through Blue Balloon and not directly.
I understand that a parent, guardian or caregiver must be present at all lessons for any students 18 and under.
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I accept.
I understand that Blue Balloon teachers and staff may take auto recordings, video recordings or photos of me/my child. The photos and videos will not be used for marketing or social media without my consent below.
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I accept.
RELEASE OF LIABILITY: I hereby release Blue Balloon Songwriting for Small People, its members, agents and volunteers of all liability. By signing this release, I understand that I am absolving and releasing others from liability from their own negligent acts, even if I am not at fault in any way. In consideration of my/my child’s participation in classes or other activities at or associated with Blue Balloon Songwriting for Small People, I agree to assume full responsibility for them, their heirs, executors, and administrators, waive and release and forever discharge any and all rights and claims for damages which they may have or which occur to them, for all damages which may be sustained and suffered by them in connection with their association with or entry into Blue Balloon Songwriting for Small People activities or which may arise out of their participation in these activities. I expressly assume all of the risks inherent in these activities.
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I release Blue Balloon of any liability as stated above.
OUR RELATIONSHIP: Our two greatest relationships when it comes to Blue Balloon are with our clients and with the fantastic music teachers in our network of independent instructors. Because this is so important to us, you agree not to directly or indirectly engage a Blue Balloon network teacher for lessons or other work and acknowledge that such action would constitute a breach of this agreement. In the event that you breach this covenant and hire any of the instructors who provide services to clients of Blue Balloon, including yourself, you will be obligated to pay Blue Balloon $10,000 in liquidated damages.
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I agree.
MEDIA CONSENT: Parent and/or Student hereby consents to and authorizes Blue Balloon Songwriting for Small People to capture and use video-audio recordings and photographic images of Student and Student’s musical performances and quoted statements in print, electronic, or online media, for educational and Blue Balloon Songwriting for Small People promotional purposes only, without any compensation to Parent or Student. Parent and/or Student agrees to waive and release any and all claims Parent may have against Blue Balloon Songwriting for Small People relating to the use of these recordings, images, or statements. This Consent is binding upon all heirs and future legal representatives. Blue Balloon Songwriting for Small People will not personally identify a minor child by full name in connection with a video recording or photographic image of the child, unless Blue Balloon Songwriting for Small People receives separate written signed consent from the Parent.
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Yes
No
CONFIDENTIALITY: By registering for lessons, I understand that my child may be taught using methods that are not publicly known and are proprietary and confidential to Blue Balloon, to the extent the instructor(s) uses Blue Balloon methods, materials, and practices. Confidential Information includes, but is not limited to, trade secrets, teaching methods, materials and practices. I agree to not copy, disclose or reveal any proprietary and/or Confidential Information to any third parties without express written consent by Blue Balloon.
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I agree.
What is your Instagram handle? We love building our wonderful Blue Balloon community! We'll follow you and you can follow us (@blueballoonschool).
Name (legal guardian's name if under 18 years old)
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Date
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Month
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Day
Year
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