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?
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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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How did you hear about Blue Balloon? If it was through word of mouth, please let us know who to thank for spreading the word!
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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).
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.
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: in case of bad weather, or if it becomes unsafe to have the lessons in-person, the lessons will take place virtually.
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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.
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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 $15,000 in liquidated damages for each teacher.
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I agree.
ACKNOWLEDGMENT BY FAMILY: Even as the Coronavirus fades in New York, we have been cautioned by public officials to maintain social distancing and, where it cannot be maintained, to wear masks. We have also been cautioned by the CDC to do a number of things such as washing hands frequently, and to avoid certain things such as touching our faces and interacting with others when we have a fever or are not feeling well. Blue Balloon fully supports all of the guidelines issued by our governor, our state and local public health officials, and the CDC. We all take risks during this public health crisis but take steps to minimize those risks. By agreeing to resume face-to-face songwriting and music instruction, the family acknowledges the risk of contracting COVID-19 and agree to protect themselves by taking all steps required by law as well as those recommended by state and local public health officials and the CDC. Parents also agree to instruct their children and all others in their household, including any other children, to take all such steps when a songwriting and music instructor is present. The instructor and the parents (on their own behalf and on behalf of their children) waive any claim against the other party and against Rachel Lipson or her company, Blue Balloon Songwriting for Small People LLC, as a result of the negligence of such party in keeping the other party free from contracting COVID-19. Stay safe and create songs and music that will lift up our spirits!
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Acknowledged and agreed by Parents of Student(s) on behalf of the Parents and their Children
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.
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E- Signature by Parent or Legal Guardian (If student is under 18 years old)
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