Student Information Form


Student Name:_________________________________________________________________________________________
(FIRST)            (LAST)

Home Address:_____________________________________________________________________________

Birthday:_______________________
                  M        D        Y

Telephone Number:  Home_____________________ Cell_________________ Email____________________


Mother's Name_____________________________________________________________________________
  (FIRST)(LAST)

Father's Name______________________________________________________________________________
(FIRST)(LAST)


LIABILITY WAIVER:  PARENT HEREBY WAIVES, RELEASES, DISCHARGES, AND COVENANTS NOT TO SUE RADAYEVA MUSIC STUDIO, IT'S OWNERS, EMPLOYEES, AGENTS, OR REPRESENTATIVES, FROM ANY AND ALL LIABILITY, ARISING OUT OF, OR RELATED TO, PARENTS OR CHILDS' PARTICIPATION IN THE EVENT/ACTIVITY/PROGRAM, WHETHER BASED IN CONTRACT OR TORT, INCLUDING ACTUAL, COMPENSATORY, INCIDENTAL, SPECIAL, CONSEQUENTIAL, PUNITIVE OR EXEMPLARY DAMAGES.
IF, DESPITE THE WAVIER, ANYONE MAKES A CLAIM AGAINST RADAYEVA MUSIC STUDIO, PARENT AGREES TO INDEMNIFY, DEFEND, AND HOLD HARMLESS RADAYEVA MUSIC STUDIO FROM ANY AND ALL CLAIMS, DEMANDS, LOSSES, ATTORNEYS FEES, COSTS, LIABILITIES OR DAMAGES AGAINST RADAYEVA MUSIC STUDIO ARISING OUT OF PARENT'S OR CHILD'S PARTICIPATION IN EVENT /ACTIVITY/PROGRAM.

Media Consent;  Parent hereby consents to and authorizes the Radayeva Music Studio to capture and use video-audio recording and photographic images of my child and/or my child's musical performance or quoted statements in print, electronic , or on line media, for educational and studio promotional purposes only, and without any compensation to me or my child.  Parent agrees to waive and release any and all claims parent may have against Radayeva Music Studio relating to the use of these, images, or statements.  This consent is binding upon heirs and future legal representatives.

Dispute Resolution;  Any controversy or claim arising out of or relating to this contract, or breach thereof, shall be settled by arbitration administered by the American Arbitration Association under it's commercial rules, and judgment on the award rendered by the arbitrator may be entered in any court having jurisdiction thereof.


Parent/Guardian:_________________________________________________________________

Date________________________________________
MDY