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AMP and Camp Participation Form

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* Required information.

 Student Information
Student's Name *
Day School *
Grade *

Parent & Guardian 
Parent's Name *
email *
phone *
Parent's Name
email
phone

Two emergency contacts (not parents)
Name *
phone *
Name *
phone *

Medical Information
Physician's Name *
Phone *
Insurance Company *
Policy Number *
Is your child taking any medicine? *
Please explain
Does your child carry an epi-pen? *
Does your child carry an inhaler for asthma? *

IMPORTANT: if your child does require an epi-pen or inhaler, you must keep one at CMC for emergency use.
Please list any allergies to food, insects, or medicine *

Please answer yes or no.  Permission to give your child:
Advil *
Benadryl *
Tylenol *

Please attach a file with further explanation or clarification of any additional medical information or details we will need to supervise your child
Choose and upload file

Pick Up

All AMP and Day Camp students will be signed in by CMC staff upon arrival to the Music Center.  All AMP and Day Camp students must be signed out by a parent or care giver and checked off the attendance list prior to leaving. 

  • Camp or Workshop extended day pick up must be by 6 pm.  AMP pick up must be by 6:30pm  
  • Please use the front door only    
  • Only authorized persons will be permitted to pick up children from the AMP program

Please list up to two (2) people permitted to pick up your child(ren) other than their parents. 
Name *
Phone *
Name *
Phone *

Media Permissions

CMC Atlanta at times receives requests from various media to do stories that the Music Center deems appropriate for our mission and therefore require the use of photos, video, and or interviewing of our students. CMC Atlanta frequently uses image, recordings, and video in communication, marketing, and promotions. Please provide your permission by initialing here:
Initials *

Payment and Withdrawal Policy

AMP enrollment is secured with Registration Fee and a two-week deposit. Tuition is paid weekly or monthly in advance. Tuition may be paid by check or by credit card online. Weekly payments must be made by auto-debit online. Please make all checks payable to CMC Atlanta. Late payments will incur a $15.00 late charge.

CMC Atlanta does not give refunds for absences due to illness, vacation, or other reason.  Private lessons can be rescheduled if 24-hours notice or if there is an emergency or illness that explains cancellation within the 24 hour window.  Parents are required to give the Center a minimum of two (2) weeks notice before withdrawing their child(ren) from enrollment in AMP. Notice of withdrawal must be in writing. The two week deposit required at registration is refunded only when the two (2) week written notice of intent to withdraw is received.

Camp or workshop participation is secured by payment of the minimum required nonrefundable deposit.  The balance of camp tuition is due the first day or participation.  Students may be blocked from participation for unpaid tuition, at the discretion of an authorized CMC Atlanta director.    

Please initial to indicate you have read and will abide with these policies and procedures:
Initials *

State Required Disclosure

CMC Atlanta offers comprehensive music training programs, and under state regulations, these programs are exempt from child care licensing. This means the supervision and care of children in AMP, the Core Program, and Studio Lessons are incidental to their participation in education and training immersion programs. CMC Atlanta is not assuming responsibility for the provision daily child care outside the scheduled programs (from arrival to departure, including scheduled classes).

In addition, under state regulations, CMC Atlanta operated Day Camps and Workshops at CMC Atlanta facilities are also exempt from child care licensing.

CMC Atlanta carries a liability insurance policy for all programs, facilities, and faculty.

Bright from the Start: GA Department of Early Care & Learning Rules and Regulations: 591-1-1-.46(b)10(vi) requires that programs shall inform Parents about the physical risks a child may face while participating in the program: Programs operated after the customary school day, as defined in Georgia law, for children five (5) years and older that are strictly instructional and skill-based in a single talent, ability, expertise, proficiency or subject or in closely related skills, proficiencies or subjects, including but not limited to classes such as art, cheerleading, dance, drama, gymnastics, martial arts and music. By signing this form I am indicating that I knowingly accept and assume the risk of injury that might occur from participation in this program. I acknowledge and understand that there is a risk of injury involved in participation and that the program, nor its trained professionals, can eliminate the risk of injury.
Initials *

Liability Waiver and Authorization for Treatment of a Minor Child

I (parent/guardian) give the Community Music Centers of Atlanta permission to seek treatment for my child, listed above, in the event of a medical emergency. I understand that every effort will be made to contact me and those I designate to contact in an emergency. If I can not be reached, and my designated emergency contact cannot be reached, my child will be transported by Emergency Medical Services to Children’s Health Care of Atlanta, Egelston, if warranted. I will not hold the CMC of Atlanta, its Directors and staff, their heirs, or dependents responsible or liable for accidents that occur while my child is attending classes. I understand that by electonrically initialing and then submitting this release form I waive my right to sue, collect damages, or charge the Center, its Directors, staff, heirs and dependents. I understand the liability of group activities, field trips, etc. is assumed and hence- forth shall be the sole and exclusive risk of the undersigned.
Initials *

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