Memorial Scholarship Registration — Sacramento County Branch

Memorial Scholarship Recital

Registration Form

This form must be filled out and signed by a parent or legal guardian. Teachers may not sign for parents or students.

Proof of age must be presented at check-in the day of the recital.

Entry fee is $36 per student, payable upon completing registration. Additional details can be found here .

Select Division

Performer's Name

First Name

Last Name

Date of birth

Proof of age required. Postmark deadline same as registration deadline.

YYYY

Title of Piece (include Movement, if any)

Composer

Instrument

Exact Timing of piece

Name of Accompanist, if using

if none, leave blank

First Name

Last Name

Does the performer require special accommodations or considerations? (E.g., accessibility, special needs, etc)

Yes

If yes, please specify:

Parent/Guardian Contact Information

Parent/Guardian

First Name

Last Name

Phone

(###)

###

####

Teacher Contact Information

Performer's Teacher

First Name

Last Name

Parent/Guardian Consent: As Parent/Legal Guardian of my child, I give my full consent and approval for my child to participate in the programs and activities of the MTAC and MTAC Branches (MTAC / Branch Program(s))

I agree

The students registered on this form agree to abide by the dress code

I Agree

Media Consent: I consent and authorize MTAC and MTAC Branches to capture, use, reproduce, and distribute images, video, and audio recordings of my child, including his/her musical performance or quoted statements, for promotional and educational purposes. I agree that use of such images and recordingd may personally identify my child by name, unless I notify MTAC or MTAC Branches otherwise in writing, and are without any compensation to me or my child. I agree to waive and release any and all claims related to the use of these images and recordings. MTAC owns the sole copyright to the images and recordings taken by MTAC.

I Agree

Privacy Policy: I agree to take video and screenshots of my child only. I understand that I may not share, distribute, or post pictures or videos of any students besides those designated on this form in any public forum, including social media, or privately, and that legal action may be taken to address violations of this policy.

I Agree

By typing your name below, you are signing this registration form electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this form.