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Student Information

Adult t-shirt size

Parent/Guardian 2

Parent/Guardian 3

Parent/Guardian 4

Emergency Contacts

Emergency Contact 1

Emergency Contact 2

Medical Information

Does your student have any medical conditions?

Students Medical information

Waiver of Liability and Hold Harmless Agreement

In consideration for participation in the MBQ Summer Brass Institute from June 19th through June 25th 2022 I hereby release, waive, discharge and covenant not to sue the Monumental Brass Quintet/ St. Mark’s Church, their officers, servants, agents, and employees (herein after referred to as “releasees”) from any liability, claims, demands, and actions and causes of actions whatsoever arising out of or relating to any loss, damage, or injury, including death, that may be sustained by my child, or any property belonging to me or my child while participating in any activities of the MBQ Summer Brass Institute or while on the premises of St. Mark’s Church. I hereby agree to indemnify and save hold harmless the releases and each of them, from any loss, damage or costs they may incur due to my child’s participation in the MBQ Summer Brass Institute. 

Photo Consent

As the parent/guardian of this student, I grant permission and give my consent for Monumental Brass Quintet to use photographs and/or video taken of your student during the Summer Brass Institute on social media or the Monumental Brass Institute website.

Early Registration (before May 1, 2020) $349

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Registration  $399

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Family Discount Rate Registration $279

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Parent/Guardian Information

Parent/Guardian 1

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