Parent/Guardian Name (required) Parent/Guardian's Cell Phone (required) Parent/Guardian Email (required) First Student's Name (required) Is this child fully vaccinated against Covid-19? Select OneYesNo Second Student's Name Is this child fully vaccinated against Covid-19? Select OneYesNo Third Student's Name Is this child fully vaccinated against Covid-19? Select OneYesNo I agree my child/children will wear a mask when called for by CDC Safety Measures, LA County Public Health & Safety measures or when required by SMMC. I agree I agree my child/children will follow all safety protocols, when required to do so, that pertain to distancing, hand washing and disinfecting procedures. I agree I agree only my child/children will be allowed to enter the lesson room. I understand the parent/guardian will have the option to vie the lesson in real time via the SMMC lesson portal. I agree I understand if my child/children is/are feeling ill or displaying symptoms of a cold or flu, he/she/they will NOT attend the lesson in-person. Instead, they will be kept home and sign into the lesson online via SMMC lesson portal. I agree I understand my child/children's physical appearance at the Center inherently increases their risk of contracting a communicable disease. I agree With full knowledge of the risk involved, I hereby release, waive, discharge San Marino Music Center from any and all liabilities or claims that may be sustained by me or my children relating to any illness. I agree By hitting "Submit" on this form, the parent/guardian named above fully consents to the information presented in this form and acknowledges to participate in SMMC's services in accordance with these guidelines. I agree Δ
