Registration Form for in person lessons

ASSUMPTION OF RISK *

I have read and understood the above warning concerning COVID-19. I hereby choose to accept the risk of contracting COVID-19 for myself and/or my children in order to utilize Queens Music Academy’s services and enter Queens Music Academy’s premises. These services are of such value to me and/or to my children, that I accept the risk of being exposed to, contracting, and/or spreading COVID-19 in order to utilize Queens Music Academy’s services and premises in person rather than arranging for an alternative method of enjoying the same services virtually.

Yes, I still want to enroll my child (ren) to take in person lessons.

WAIVER OF LAWSUIT/LIABILITY *

I hereby forever release and waive my right to bring suit against Queens Music Academy and its owners, officers, directors, managers, officials, trustees, agents, employees, or other representatives in connection with exposure, infection, and/or spread of COVID-19 related to utilizing Queens Music Academy’s services and premises. I understand that this waiver means I give up my right to bring any claims including for personal injuries, death, disease or property losses, or any other loss, including but not limited to claims of negligence and give up any claim I may have to seek damages, whether known or unknown, foreseen or unforeseen.

CHOICE OF LAW: I understand and agree that the law of the State of New York will apply to this contract.

Parent's Name(s) *

First Name

Last Name

Student(s)'s Name *

First Name

Last Name

Phone *

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date

MM

DD

YYYY