Guardian Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

In case of emergency during class time, whom should we call? *

First Name

Last Name

Emergency Contact Number *

The number of the person named above.

(###)

###

####

FOR HIGH SCHOOL STUDENTS ONLY:

My student has permission to leave the festival unaccompanied at the end of each day.

Yes

No

Does your student have any allergies? *

Yes, my student has allergies.

No, my student does NOT have allergies.

Does your child need any accommodations?

Please check all that apply.

Food Allergies

Social/Emotional

Vision

Hearing

Speech

Physical

Specific Learning Disability

Language

Other

Linda Luebke Strings Festival Photo Notice I hereby understand the Linda Luebke Strings Festival an Indiana not-for-profit corporation, (“LLSF”) has permission to use the likeness of(in addition to my own likeness) in a photograph in any and all of its publications, including website entries, without payment or any other consideration. I understand and agree that these materials will become the property of LLSF and will not be returned. I hereby irrevocably authorize LLSF to edit, copy, exhibit, publish or distribute photographs of my child for purposes of marketing LLSF’s festival. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my child’s or my own likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph. I hereby hold harmless and release and forever discharge LLSF from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other person acting on my behalf or on behalf of my estate have or may have by reason of this Photo Release. I have read this Photo Release before checking below and I fully understand the contents, meaning, and impact of this Photo Release and I fully understand the contents, meaning and impact of this Photo Release. As such, I do hereby give my consent without reservation to the foregoing on behalf of the below - named minor and myself. *

Guardian Name

First Name

Last Name