Summer Camp Form | Machiko Music

Camp Participant Release and Waiver

What’s your first name?

What’s your last name?

What’s your email address?

What’s your phone number?

I authorize and grant permission for a representative of Machiko Music, LLC to treat minor injuries including scrapes, small cuts, and splinters. I authorize and grant permission for a representative of Machiko Music, LLC to obtain emergency medical care from any licensed physician or hospital and/or medical clinic should my child become ill or injured. I therefore freely and voluntarily execute this release with such knowledge, assume the risk of personal injury and/or property loss arising from in any way connected with participation in any programs offered by Machiko Music, LLC. I hereby release and discharge Machiko Music, LLC and any and all agents of Machiko Music LLC from any liability, claim, cause of action, demand or damages from injury or damages of any kind to my child or my property as a result of participation in the programs of Machiko Music, LLC. I grant permission and understand that photos and other images taken during this event could be used to print advertisement and other forms of media. I understand that should my child become a disruptive force during the educational program that the instructor may chose to release him/her from the program with no refund.

Early Bird Special Summer Camps 2026

Camp Participant Release and Waiver

FOLLOW US

LET'S GET STARTED