The Music Institute at HCC 2019-2020 Consent Form
Please fill in the information below. This form will be kept on file in the offices of TMI. Submission of this form to the Music
Institute office is necessary in order to complete the registration process.
THIS FORM MUST MATCH THE REGISTRATION BEING SUBMITTED.
Please type or print the following:
1. Student Name __________________________________________________________________________
2. Type of lesson or Name of class/ensemble _____________________________________________________
3. Teacher’s Name (private lessons or classes/ensembles) ___________________________________________
Please mark your replies with a check mark/circling as they apply to your registration. Please complete all of the questions.
1. Are you registering for private lessons? Yes No
2. If yes, length of Lessons: 30 min. 45 min. 60 min.
3. Numerical section(s) for which you are registering (please mark box under desired section or sections):
Term 2019A2 Term 2020A1 Term 2020A2
3. Are you registering for classes/ensembles? Yes No
Media Permission (Please place an X in the appropriate field)
My child has my permission to be photographed, interviewed, audiotaped, or videotaped while attending lessons,
rehearsals, classes, or recitals for possible use in marketing including Facebook and YouTube.
My child does not have my permission to be photographed, interviewed, audiotaped, or videotaped while attending
lessons, rehearsals, classes or recitals for possible use in marketing including Facebook and YouTube.
Please place an X in this box to indicate agreement to the waiver of responsibility statement below.
I/We understand and voluntarily assume all risks inherent in the nature of this activity and I/we waive and release all claims,
costs, liabilities, expenses and judgments against HCC and its representatives arising out of my participation or my child’s
participation in the activity at The Music Institute. HCC and The Music Institute are not responsible for personal items brought or
left on campus. DO NOT BRING: Games, toys, trading cards, electronic devices unless expressly required by the instructor for
the class, lesson, or rehearsal. All cell phones must be turned off during class hours. HCC is not responsible for lost, broken, or
missing personal items or instruments.
Responsible Party Signature (may not be a minor).
In order for the student to be officially registered this form must be signed and dated.
I certify that I am registering myself or my minor child for lessons, ensembles, or classes at The Music Institute and that the
information presented herein is correct to the best of my knowledge. I understand that it is my responsibility to notify The Office
of Records, Registration & Veterans’ Affairs and The Music Institute Office of any change in the information contained in this
application. I will take financial responsibility for the tuition and fees due to HCC.
Responsible Party’s Name ______________________________________________________________
All charges due to Howard Community College (HCC) must be paid in full by the published payment due date. Past due
balances are subject to collection and fees up to 25% of the original balance. Students whose accounts are delinquent will not be
permitted to register for the next term or receive official transcripts and diplomas. HCC may require payment in the form of
certified funds, such as cash, money order, credit card, or cashier’s check.
Responsible Party’s Address (If different from the student’s address listed on the Student Information Sheet)
__________________________________________________________________________________________________
Responsible Party’s Signature _____________________________________________Date __ __ /__ __ /__ __
