Student Registration Form

Register your first (or only) student:

Student #1*

First Last

Nickname (if different) for Name Badge:

Student #1 Birthdate*

Instrument*

Student #1 Private Teacher's Name:

Student #1 Private Teacher Phone:

Student #1 Private Teacher Email:

Choose Curriculum Level for Student #1

Please note: This is the curriculum level you paid for in the first step of this process.

Student Curriculum Choices Student #1*

Choose one from the dropdown below:

Section A.

Twinkle level - (Fill out only if student is doing Twinkler curriculum.)

Section B.

Musicianship Level & Working/Polished Pieces:

Book 1 & 2 students choose Musicianship Level, please refer to our page to determine your child's appropriate level.

Working Piece Book (1-9)

Please enter a number from 1 to 9.

Working Piece Song (1-25)

Please enter a number from 1 to 25.

Name of Working Piece Song:

Polished Piece Book (1-9)

Please enter a number from 1 to 9.

Polished Piece Song (1-25)

Please enter a number from 1 to 25.

Name of Polished Piece Song:

Section C.

Enrichment Selections: (Fill out if in Book 1 & Up or Chamber Music Prep)

You will receive one of the following enrichment options with your registration, please list the ones you're interested in in order of preference (1,2,3,4):

Choice 1

Choice 2

Choice 3

Choice 4

Opt Out of Enrichment

I prefer not to be scheduled in any enrichment classes. I realize that there is no reduction in the tuition fee if I choose this option.

Opt Out

General Contact Information

Following is information about your entire family - this information applies to your family.

I agree to receive texts during the institute:*

Yes
No

Primary Phone for text alerts*

Please add information for all adults who will be attending below:

Adult #1

Please enter First and Last Name, Nickname (if different) for Name Badge)

Adult #1 Phone

Adult #2

Please enter First and Last Name, Nickname (if different) for Name Badge)

Adult #2 Phone

Adult #3

Please enter First and Last Name, Nickname (if different) for Name Badge)

Adult #3 Phone

Photo Release*

I agree

I hereby grant the Colorado Institute of Music permission to use my child/children's likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration. I understand and agree that all photos will become the property of the Colorado Institute of Music and will not be returned. I hereby irrevocably authorize the Colorado Institute of Music to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo. I hereby hold harmless, release, and forever discharge the Colorado Institute of Music from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

COVID19*

I agree

WHEREAS, the World Health Organization has declared the recent coronavirus disease 2019 (COVID-19) a pandemic; and
WHEREAS, recently, community-wide transmission of COVID-19 has occurred in the United States, including in the area where the Institute provides services; and
WHEREAS, the community spread of COVID-19 is difficult to detect and control; and
WHEREAS, the Agency cannot guarantee that attendees and employees are not unknowingly carrying or infected with COVID-19; and
WHEREAS, the Client nevertheless desires to continue to receive services from the Institute and its employees;
NOW, THEREFORE, for good and valuable consideration, the sufficiency of which is acknowledged, the Parties agree as follows:
1. In recognition of the relative risks and benefits of services provided by the Institute, Attendee assumes all risks other than gross negligence by the Institute. Attendee agrees to the fullest extent of the law that Institue and its officers, directors, members, employees, independent contractors, successors, and assigns shall not be liable if Attendee contracts COVID-19 and/or suffers any complications from contracting COVID-19, including death. Attendeee also agrees to hold harmless and promises not to sue the Institute and its officers, directors, members, employees, independent contractors, successors, and assigns from and against any and all causes of action, obligations, losses, liabilities, penalties, claims, damages, actions, suits, proceedings, settlements, judgments, and costs and expenses (including reasonable attorneys’ fees) arising out of, or in connection with, Attendee being diagnosed with COVID-19 and any subsequent complications from the disease, including death, except for gross negligence or as otherwise prohibited by law.
2. This Agreement is meant to supplement, but not supersede any other agreement between the Parties, except where they might conflict in which case this Agreement shall control.
3. This Agreement shall survive the termination of the Institute services to Attendee.
4. This Agreement shall be governed by the laws of the State of Colorado, without regard to choice of law principles.
ATTENDEE REPRESENTS THAT HE OR SHE HAS FULLY INFORMED HIMSELF OR HERSELF OF THE CONTENTS OF THIS AGREEMENT NOT TO SUE BY READING IT BEFORE HE OR SHE SIGNED IT, THAT HE OR SHE UNDERSTANDS ALL OF THE TERMS OF THIS AGREEMENT AND ENTERS INTO THIS AGREEMENT VOLUNTARILY.

Student Registration Form

Register your first (or only) student:

Choose Curriculum Level for Student #1

Section A.

Section B.

Section C.

General Contact Information

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