Please choose the days and locations that will work for your child to attend the lessons. *

Tuesdays 4-5 p.m. at Family Centre White Oaks, 565 Bradley Ave , London

Wednesdays 4-5 p.m. at Family Centre Carling-Thames 335 Belfield St, London

Student's Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Student's Grade

Please note the program is for students in grades 7, 8, 9 or 10.

Grade 7

Grade 8

Grade 9

Grade 10

Parent's / Guardian's Name *

First Name

Last Name

Parent's / Guardian's Home Phone *

(###)

###

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Media Release *

I, the parent/guardian, hereby authorize Investing in Children to use or alter any photographs/videos of myself and/or my child(ren), or any written comments/testimonials, etc., for reproduction on Investing in Children’s website, social media platforms, published promotional materials such as (but not limited to) display boards, annual reports, flyers, emailers, etc. without any expectation of compensation.

I, the parent/ guardian, understand and agree to the Media Release

Attendance Agreement *

For the safety of all involved, participation in this program requires collaboration, excellent listening skills and full co-operation of all students. For the safety of all, any student not co-operating, not following directions by the instructor, or not communicating properly, (ex. using profanity, causing a disturbance, or threatening any other person involved in this program), will need to be suspended or removed from the program. Parents will be notified in the event a youth is not cooperating and/or participating as expected. Investing in Children reserves the right to make this decision.

I, the parent/ guardian, understand and agree to the Attendance Agreement

Do you own a six-string acoustic guitar that you can use during all lessons? *

Yes

No

Guitar Loan Agreement *

As a parent/guardian of a youth participating in Investing In Children’s Free Guitar Program I understand that the Free Youth Guitar Program is designed to teach youth how to play guitar. I also understand that the replacement value of the guitar is $300.00. I agree to accept full financial responsibility of ensuring that the guitar will be returned to Investing in Children staff immediately following the last scheduled lesson. It will be returned in the same condition that it was received in. I fully agree to accept responsibility for any repairs required, as determined by the Investing in Children staff, during the lesson period my youth holds it in possession; notwithstanding how the damage is caused. If the damage is beyond reasonable repair, I agree to forward the sum of $300.00 to Investing in Children, to cover its cost. If the guitar has been damaged (scratches, cracks, etc.), and yet is reasonably “playable”, I agree to cover the depreciated value of the instrument, caused by the damage. This amount will be determined by the Investing in Children staff, in conjunction with a music store.

I, the parent/ guardian understand and agree to accept the terms in the guitar loan agreement above

We own a guitar and do not need to borrow one from IIC.