ADULT STUDENT / PARENT / GUARDIAN INFORMATION

STUDENT INFORMATION

Adult students, please enter your name again.

Instrument
Teacher's Name*

MEDICAL & EMERGENCY INFORMATION


IN CASE OF EMERGENCY, AND THE EVENT THAT WE ARE UNABLE TO REACH FAMILIES OR EMERGENCY CONTACT PERSON IN A TIMELY FASHION, SIGN HERE TO GIVE PERMISSION FOR THE STAFF TO SEEK MEDICAL TREATMENT SUCH AS, BUT NOT LIMITED TO, CALLING AN AMBULANCE OR TAKING STUDENT TO AN EMERGENCY ROOM: