Mariachi Jump Start Registration Application
Student First Name:
Student Last Name:
(Please note that instruments are "first come, first served." Selecting this option does not guarantee that we will be able to provide an instrument for the student.)
*In case of an emergency, we will attempt to contact the parent/guardian using the phone number entered above. Since your child's safety and wellbeing are of utmost importance, we ask that you also provide an additional emergency contact in case the parent/guardian listed above cannot be reached.
Please fill out a SEPARATE registration form for each student!
1. I understand that the Mariachi Jump Start summer program does not provide insurance coverage for any medical care needed because of my child's participation in the Mariachi Jump Start workshops on June 11th through June 15th, 2018.
2. I also understand that there are certain risks and hazards that may arise in the course of this summer program and hereby assume the inherent risks and hazards of my child's participation in this summer program.
3. I acknowledge that claims for damages against the Mariachi Jump Start summer program will be governed by the laws of the State of New Mexico.
4. I hereby grant permission for the Mariachi Jump Start summer program to use any photographs and/or videos of my child, with or without their name, for any lawful purposes such as publicity, illustration, advertising, and Web content.
By typing my name below, I certify that I agree with the statements above.
(Note that a Youth L is the same size as an Adult S, except that the Adult sizes are longer than the Youth sizes.)
Which grade level will the student be entering in the upcoming (2018-2019) school year?
Which class are you interested in?
Does the student have access to this instrument?
Yes, the student will bring their own instrument.
No, the student will need to borrow an instrument.
Does the student have any previous experience playing this instrument?
No, the student has never played this or any other instrument before.
No, the student has never played this instrument, but does currently play a different instrument.
Yes, the student has been playing this instrument for less than 1 year.
Yes, the student has been playing this instrument for 1 to 2 years.
Yes, the student has been playing this instrument for more than 2 years.
What is the student's T-Shirt size?
Parent/Guardian First Name:
Parent/Guardian Last Name:
*Parent/Guardian Phone Number:
Parent/Guardian Email Address:
Home Address: (Full Street Address, City, State and Zip Code)
Emergency Contact First Name:
Emergency Contact Last Name:
Emergency Contact Phone Number:
Relationship to Student:
Parent/Guardian Electronic Signature:
Please read the following statements carefully.