Online Registration

Class Apply For (required)

How did you hear about us

What class you want to apply for

Choose the type of enrollment you want

Days you would prefer for lessons

Times they would prefer for lessons

Student Personal Information (required)

First Name

Last Name

Age

Student Address Information

Address

City

State

Zip code

The Student-2 Personal Information (Optional)

First Name

Last Name

Age

Parent/ Guardian Information (Required)

First Name

Last Name

Phone Number

Emergency Contact Information (Required)

First Name

Last Name

Phone Number

Relationship

Student Health Information (Required)

Please provide information about any allergies, chronic illnesses, or medical conditions the student may have.

Please provide any instructions if the student is prescribed an inhaler.

Acknowledgment (Required)

Check the mark if you agreed with the policy

Informed Consent and Acknowledgement I hereby provide my consent for my child to participate in all activities organized by Hesperia Music Academy. By accepting my child's participation, I acknowledge and accept all the risks and hazards that may be associated with the activities. I release, absolve, and hold harmless Hesperia Music Academy, along with its officers, agents, and representatives, from any and all liability for any injuries sustained by my child while traveling to, participating in, or returning from Hesperia Music Academy activities. In the event of any injury to my child, I waive all claims against Hesperia Music Academy, including its teachers, affiliates, participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of the premises where the event takes place. It is understood that there are inherent risks of injury associated with all music-related activities. By providing my approval, I acknowledge that I have read and understood the above terms and agree to them on behalf of my child's activities at Hesperia Music Academy.

Check the mark if you agreed with the policy

Medical Release and Authorization As the parent and/or guardian of the named Student, I hereby grant authorization for qualified and licensed medical professionals at Hesperia Music Academy to diagnose and treat my minor child in the event of a medical emergency. This authorization is applicable when immediate attention is deemed necessary by the attending medical professional to prevent further endangerment of the minor's life, physical disfigurement, physical impairment, or any other undue pain, suffering, or discomfort if delayed. I understand that in the event of a serious illness, the need for major surgery, or a significant accidental injury, the staff will make every attempt to contact me as quickly as possible. However, I acknowledge that in emergency situations, efforts to reach me may be prioritized for the well-being of my child. I also grant permission to the Hesperia Music Academy and its affiliates, including directors, teachers, and team parents, to provide necessary emergency treatment to my child before their admission to a medical facility. I willingly and voluntarily authorize this release, solely for the purpose of authorizing medical treatment under emergency circumstances, to protect the life and well-being of my named minor child in my absence.

Check the mark if you agreed with the policy

Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Signature (Required)

Please write your full name as signature

Online Registration

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