STUDENT'S NAME:____________________________________________________________

PARENT'S NAME(S):___________________________________________________________

ADDRESS:_____________________________________________________________________

______________________________________________________________________________

E-MAIL ADDRESS:_____________________________________________________________

PHONE:__________________________

OTHER PHONE:______________________

PLEASE CHECK HERE IF THIS FORM IS FOR A 2ND CHILD ________

WHEREAS, THE UNDERSIGNED VOLUNTARILY ASSUMES ALL RISK OF ACCIDENT OR PERSONAL INJURY OR DAMAGE TO HIS OR HER PERSON, CHILD, OR PROPERTY AND HEREBY RELEASES THE OHIO CONSERVATORY OF MUSIC AND THE UNIVERSITY OF AKRON, ITS AGENTS, EMPLOYEES AND REPRESENTATIVES FROM EVERY LIABILITY CLAIM OR DEMAND OF ANY KIND SUSTAINED, INCLUDING BUT NOT LIMITED TO THE LOSS OF PERSONAL PROPERTY, SICKNESS AND INJURY FROM WHATEVER SOURCE, LEGAL ENTANGLEMENT OR OTHERWISE WHILE PREPARING FOR, PARTICIPATING IN OR TRAVELING TO AND FROM SAID ACTIVITIES.

THAT, THE UNDERSIGNED DECLARES THAT S/HE HAS NO PHYSICAL DISABILITIES, HANDICAP, ALLERGIES, OR HEALTH OF PHYSICAL CONDITIONS OTHER THAN THOSE OF WHICH S/HE HAS GIVEN NOTICE IN WRITING TO THE OHIO CONSERVATORY OF MUSIC.

THAT, THE UNDERSIGNED, BY SIGNING THIS RELEASE, HEREBY CERTIFIES THAT S/HE HAS READ AND FULLY UNDERSTOOD THE TERMS AND CONDITIONS HEREIN PROVIDED AS WELL AS THE REQUIREMENTS STATED ON THE ABOVE REGISTRATION FORM, AND AGREES TO THESE TERMS AND CONDITIONS.

SIGNATURE:_____________________________________________DATE:____________________

*Please not that under no circumstances may any minor be left unattended while in Guzzetta Hall or on the University of Akron Campus for any function connected to the Ohio Conservatory of Music. This includes dropping children off from cars. They must be walked into the building. Your signature at the bottom of the registration form confirms that you have read this notice carefully and agree to comply.