Virtual Private Music Lesson Enrollment Form

  • Date Format: MM slash DD slash YYYY
  • (for the 2020 - 2021 school year)
  • (for the 2020 - 2021 school year)
  • Instructors will use this information to create lesson plans and prepare material that is parallel to your goals.
  • All online/virtual activities and classes will comply with the Boys & Girls Clubs of Benton and Franklin Counties Safety Policies. Instructors and youth will use Zoom in a safe and appropriate way, and virtual lessons will be regularly supervised to ensure we are creating a safe online environment. After downloading Zoom, youth will also need to set-up their phone, tablet, or computer in a safe and quiet setting to maximize learning. MAC instructors will record all virtual private lessons so they can be reviewed at anytime. Parents/guardians may request a copy of any recording or they may record any and all lessons on their own. All Zoom private lessons will be password protected and will not be open to other youth. Your instructor will send you the Zoom Meeting ID and Password before each lesson so you can login.
  • I agree to abide by the terms and conditions of the Boys & Girls Clubs of Benton and Franklin Counties (BGCBFC) Parent Handbook. I agree that the BGCBFC, its employees, Board of Directors and affiliated agencies, shall not be liable for any claims, demands, injuries, damages, or actions to me or to my child as a result of my child’s involvement in BGCBFC programs or activities. By signing my permission below, I give permission for the BGCBFC to use photographs and other types of media of my child for promotional purposes. If I wish to revoke this permission, I will specifically request a Public Relations Denial form. BGCBFC may share information about the child(ren) listed on this application with Boys & Girls Clubs of America (BGCA) for research purposes and/or to evaluate the program’s effectiveness. Information that will be disclosed to BGCA may include the information provided on this membership application form, information provided by the child’s school or school district, and other information collected by the BGCBFC. All information provided to BGCA will be kept confidential. I understand the implication of this Permission and Statement of Release. I certify that I am legally capable of executing this agreement, and that I have so of my own free will on the date indicated below, on behalf of myself, my spouse, if not signed separately, and our child for whom this form was prepared. I further certify that all information provided is the most current and understand that it is my duty to update this information should anything change.
  • Use the text box below to add any comments or ask any questions you may have regarding the private lesson you are signing up for.