Waivers

These waivers are in place for everyone's safety and are mandatory for placement in the studio.

Please let us know if there are any changes to your answers, and we will update your preferences.

Parents or guardians of children under the age of 18 will be asked to provide a list of approved adults for student drop off & pick up or sign a waiver that allows the student to leave the property unattended.
Parents or guardians must provide relevant contact information of approved adults to Kossak Music Studio (KMS) in the consent form.

Adult First Name

Adult Last Name

Email

Phone

Address

How did you hear about us?

Student Name 1

Student Birthday

Student Name 2

Student 2 Birthday

This Person is my Emergency Contact and Approved Adult*

Name of Adult 1

Phone Number for Adult 1

This Person is my Emergency Contact

Name of Adult 2

Phone Number for Adult 2

We'll only contact this person in an emergency.

If you would like to add more approved adults or emergency contacts, please submit their information to Admin@KossakMusicStudio.com

Kossak Music Studio does not authorize the uploading of any recorded media created in our studio to social media or the public internet. The materials produced here serve as learning aids exclusively for our students and are not intended for public consumption.
Kossak Music Studio video records all lessons which are then stored on a private server on the premises. Tapes are never released for any reason and are in place for safety reasons.

I conset to having all lessons recorded.

I consent to the use of my or my student's likeness, including video, audio, photos, and testimonials, on our social media pages.

Thank you for submitting!