Free Classes Registration — BASMA at Historic Westside

1

Photo / Video Release

Optional ▼

Photo / Video Release

I grant BASMA LLC permission to use photographs, video recordings, and audio recordings of the student taken during BASMA classes.

Permitted Uses:

Social media (Instagram, TikTok, Facebook, YouTube)
Website, flyers, ads, press
Showcase and performance recordings

Valid for 3 years. Revoke anytime by emailing majorwinnersleague@gmail.com.

I DO NOT consent to photo/video use. (My child may still participate.)

Parent/Guardian Signature

✍️ Sign here

2

Medical & Emergency Info

Optional ▼

Medical Information

Kept confidential — used only for emergencies during class.

Emergency Authorization: If you can't be reached, you authorize BASMA staff to call 911 and authorize emergency treatment.

Emergency Contact

Emergency Contact Name

Emergency Phone

Relationship to Student

Medical Details

Allergies (food, medication, environmental)

Medical Conditions or Medications

Emergency Medical Authorization — Signature

✍️ Sign here

3

Pickup Authorization

Optional ▼

Pickup Policy

Photo ID required at every pickup
Pickup at 2:00 PM
Students will NOT be released to unauthorized persons
Changes: email majorwinnersleague@gmail.com

Authorized Pickup Persons

Who can pick up this student? (Photo ID required.)

#	Full Name	Relationship	Phone
1
2

Parent/Guardian Signature

✍️ Sign here

4

Liability Waiver

Optional ▼

⚠️ Please Read Carefully

By signing, you are waiving certain legal rights, including the right to sue.

Acknowledgment of Risk: Participation involves music activities, vocal exercises, performance/stage activities. These carry inherent risks including minor injuries and muscle strain.

Release of Liability: I release BASMA LLC, its owners, employees, instructors, volunteers, and the Historic Westside Education & Training Center from any liability arising from participation.

Governing Law: State of Nevada. Disputes resolved in Clark County.

Parent/Guardian Signature

✍️ Sign here

5

Student Code of Conduct

Optional ▼

Student Expectations

Respect: Treat all instructors, staff, and students with kindness
Participation: Engage in activities and follow guidance
Safety: Use equipment responsibly
Inclusivity: Zero tolerance for bullying or harassment

Disciplinary: 1st — verbal warning · 2nd — parent contact · 3rd — possible suspension · Severe — immediate removal

Student Signature (if 10+, optional)

✍️ Student signs (optional)

Parent/Guardian Signature

✍️ Sign here

By submitting, you agree to the above sections.

Free 1-Week Trial Registration

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Complete Registration Paperwork

Photo / Video Release

Medical Information

Pickup Policy

⚠️ Please Read Carefully

Student Expectations

All Done! 🎶