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AMP and Camp Participation Form

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* Required information.

 Student Information

Student's Name *
Day School *
Grade *

Parent & Guardian 

Parent's Name *
email *
phone *
Parent's Name
email
phone

Two emergency contacts (not parents)

Name *
phone *
Name *
phone *

Medical Information

Physician's Name *
Phone *
Insurance Company *
Policy Number *
Is your child taking any medicine? *
Please explain
Does your child carry an epi-pen? *
Does your child carry an inhaler for asthma? *

IMPORTANT: if your child does require an epi-pen or inhaler, you must keep one at CMC for emergency use.

Please list any allergies to food, insects, or medicine *

Please answer yes or no.  Permission to give your child:

Advil *
Benadryl *
Tylenol *

Please attach a file with further explanation or clarification of any additional medical information or details we will need to supervise your child

Choose and upload file

Pick Up

All AMP and Day Camp students will be signed in by CMC staff upon arrival to the Music Center.  All AMP and Day Camp students must be signed out by a parent or care giver and checked off the attendance list prior to leaving. 

  • Pick-up must be by 6:30pm  
  • Please use the front door only    
  • Only authorized persons will be permitted to pick up children from the AMP program

Please list up to two (2) people permitted to pick up your child(ren) other than their parents. 

Name *
Phone *
Name *
Phone *

Media Permissions

CMC Atlanta at times receives requests from various media to do stories that the Music Center deems appropriate for our mission and therefore require the use of photos, video, and or interviewing of our students. CMC Atlanta frequently uses image, recordings, and video in communication, marketing, and promotions. Please provide your permission by initialing here:

Initials *

Payment and Withdrawal Policy

AMP enrollment is secured with Registration Fee and a two-week deposit. Tuition is paid weekly or monthly in advance. Tuition may be paid by check or by credit card online. Weekly payments must be made by auto-debit online. Please make all checks payable to CMC Atlanta. Late payments will incur a $15.00 late charge.

The Music Center does not give refunds for absences due to illness, vacation, or other reason. Parents are required to give the Center a minimum of two (2) weeks notice before withdrawing their child(ren) from enrollment. Notice of withdrawal must be in writing. The two week deposit required at registration is refunded only when the two (2) week written notice of intent to withdraw is received.

Please initial to indicate you have read and will abide with these policies and procedures:

Initials *

State Required Disclosure

CMC Atlanta offers comprehensive music training programs, and under state regulations, these programs are exempt from child care licensing. This means the supervision and care of children in AMP, the Core Program, and Studio Lessons are incidental to their participation in education and training immersion programs. CMC Atlanta is not assuming responsibility for the provision daily child care outside the scheduled programs (from arrival to departure, including scheduled classes).

In addition, under state regulations, CMC Atlanta operated Day Camps and Workshops at CMC Atlanta facilities are also exempt from child care licensing.

CMC Atlanta carries a liability insurance policy for all other programs, facilities, and faculty.

IMPORTANT NOTE: students in 6th grade and above who attend the Summer Performance Workshop full day in Little 5 Points or Dunwoody are allowed to leave the Center with peers for lunch, but only with advanced parental permission. When determining whether to give your 6th grade student or older permission to eat at a nearby restaurant, please be advised that CMC faculty will not be able to accompany the students on their lunch outing. Also, food delivery is an option for 6th graders and up.

Liability Waiver and Authorization for Treatment of a Minor Child

I (parent/guardian) give the Community Music Centers of Atlanta permission to seek treatment for my child, listed above, in the event of a medical emergency. I understand that every effort will be made to contact me and those I designate to contact in an emergency. If I can not be reached, and my designated emergency contact cannot be reached, my child will be transported by Emergency Medical Services to Children’s Health Care of Atlanta, Egelston, if warranted. I will not hold the CMC of Atlanta, its Directors and staff, their heirs, or dependents responsible or liable for accidents that occur while my child is attending classes. I understand that by electonrically initialing and then submitting this release form I waive my right to sue, collect damages, or charge the Center, its Directors, staff, heirs and dependents. I understand the liability of group activities, field trips, etc. is assumed and hence- forth shall be the sole and exclusive risk of the undersigned.

Initials *

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