Select this box to register for the SSI Violin/Viola concerto competition. Details are available here: https://www.wku.edu/strings/concerto.php
Individuals who may be contacted in the event the parent(s)/primary guardian cannot be reached.
Student Pickup Information
List of individuals, other than parents, allowed to pick your child up from the camp. Make these individuals aware that picture ID will be required before your child will be allowed to leave with them.
Parent Consent Statement
As the parent/guardian, I certify that my child has my permission to participate in this summer music camp. I understand that he/she will be subject to the regulations of Western Kentucky University. I also agree that my child will follow the instructions of the camp personnel and will treat other campers/adults with courtesy and respect. I understand that if my child fails to do so, he/she will not be allowed to participate in the camp.
All risks associated with participating in the program, including but not limited to bodily injury, are assumed by me, as indicated by the signature below.
I understand that during music camp, participating students may be asked to complete assessment instruments that are judged appropriate. I give my permission for my child to complete these assessments and for the data to be used in research studies with the understanding that such studies will make no reference to specific students.
I understand that photographs and videos may be taken to document activities. I give my permission for photographs and/or videos to be taken of my child during the camp to be used for educational and/or promotional materials for the Department of Music and the WKU Pre-College Strings Program.
I release and discharge Western Kentucky University, its employees, agents, and/or officers, from any and all claims, demands or damages which may arise from loss or injury of any nature as a result of any act of proven negligence on the part of the University, its employees, agents and/or officers, while my child is participating in this camp. I further agree to indemnify and hold harmless the University, its employees, agents, and/or officers from any and all loss, damage, or expense incurred.
I certify that my child’s immunizations are current and understand that I will be notified should a health emergency arise. If I cannot be reached by telephone, I authorize whatever medical treatment is deemed necessary by medical personnel.
Click here to download a PDF copy of this Consent Statement.