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Welcome to Lundstrum’s Private Lesson Inquiry Form.
Complete this form if you are a new or returning student* wishing to inquire about private lessons.

*If you are a student under the age of 18, make sure that your parent or guardian is submitting this form.

General

A new student has not taken private lessons at Lundstrum. A returning student has previously attended Lundstrum for private lessons.

Student Info





Non-Comcast emails are preferred to ensure the best chance of receiving a reply.


We use this data to show the diverse representation of our student body in our annual report for donors and grants.


Address




Parent/Guardian Info




Non-Comcast emails are preferred to ensure the best chance of receiving a reply.

Address






Additional Parent/Guardian Info




Non-Comcast emails are preferred to ensure the best chance of receiving a reply.


If no, you will be asked to provide an additional address.
Address





Emergency Contact Info
Youth students: in case the guardians cannot be reached, who should we contact?
Adult students: who should we contact in case of an emergency?

Please provide First Name, Last Name, and Phone Number of the emergency contact as well as their relationship to you/your student (i.e. sibling, family friend, grandparent, etc.).

Referral Info


Who referred you to us?
Private Lesson Inquiry






Examples: "I have an audition in two weeks", "no time frame, just looking for training"

Choose as many as you like.

Choose as many as you like.

Choose as many as you like.

Choose as many as you like.

Choose as many as you like.

Choose as many as you like.

Choose as many as you like.



Waivers, Policies, and Liability Release Forms

Adult: Photography & Videography Waiver

We require you to agree to the following photography and videography waiver.

I give my permission for Lundstrum Center for the Performing Arts to include my first name, photograph, video, and/or story in marketing programs and fundraising appeals in order to generate more scholarships for students of the Lundstrum Center. May lat name will not be used 

Youth: Photography & Videography Waiver

We require you to agree to the following photography and videography waiver.

I give my permission for Lundstrum Center for the Performing Arts to include my son/daughter’s first name, photograph, video, and/or story in marketing programs and fundraising appeals in order to generate more scholarships for students of the Lundstrum Center. My child’s last name will not be used.

Adult: Liability Release Form

This form must be signed by all persons participating in activities of the Lundstrum Performing Arts.


The undersigned, being fully aware of the risks that go along with dancing, singing, acting, and related performing activities, shall hereby:

1. Bodily Injury. I assume all risks of bodily injury and property damage inherent in dancing, singing, acting, and related performing activities at Lundstrum Performing Arts and observing or attending any event. This Liability Release shall apply whether the injury or loss occurs at the studio, within or outside the building, or at any event occurring off the premises. Lundstrum Performing Arts is not responsible for injuries sustained during lessons, workshops or performances.

2. COVID-19. With full knowledge of the risks involved, I hereby release, waive, discharge the Organization, its board, officers, independent contractors, affiliates, employees, representatives, successors, and assigns from any and all liabilities, claims, demands, actions, and causes of action whatsoever, directly or indirectly arising out of or related to any loss, damage, injury, that may be sustained by me related to COVID-19 while participating in any activity while in, on, or around the premises or while using the facilities that may lead to unintentional exposure or harm due to COVID-19.

3. Release and hold harmless the staff, agents, and employees of Lundstrum Performing Arts from all liability to me, my child, my personal representatives, assigns, heirs, and next of kin, against any claim or cause of action which I, or anyone claiming by, through or under me, may at any time have against those hereby released arising out of bodily injury (including death), property damage, loss or theft of articles suffered by me or my child while dancing, singing, acting, performing, at Lundstrum Performing Arts and/or attending any event whether or not held at the premises.

4. Have read and agreed to abide by the Lundstrum Performing Arts policies as amended from time to time.

5. I authorize Lundstrum Performing Arts (LPA) to photograph & videotape me while participating in an LPA program or an LPA field trip. I understand that the photographs and video footage that may be used to publicize the program will always be used in a positive manner. I also understand that all photographs and video footage are the property of LPA.

6. Lundstrum Performing Arts reserves the right to cancel or restructure classes that do not meet minimum enrollment requirements.

7. Lundstrum Performing Arts is not responsible for lost or stolen personal belongings.

8. By signing this document I agree to the release statements listed above.

Youth: Liability Release Form

This form must be signed by all persons participating in activities of the Lundstrum Performing Arts.


The undersigned, being fully aware of the risks that go along with dancing, singing, acting, and related performing activities, shall hereby:

1. COVID-19. With full knowledge of the risks involved, I hereby release, waive, discharge the Organization, its board, officers, independent contractors, affiliates, employees, representatives, successors, and assigns from any and all liabilities, claims, demands, actions, and causes of action whatsoever, directly or indirectly arising out of or related to any loss, damage, injury, or death, that may be sustained by me related to COVID-19 while participating in any activity while in, on, or around the premises or while using the facilities that may lead to unintentional exposure or harm due to COVID-19.

2. Assume all risks of bodily injury (including death) and property damage inherent in dancing, singing, acting, and related performing activities at the Lundstrum Performing Arts and observing or attending any event. This Liability Release shall apply whether the injury or loss occurs at the studio, within or outside the building, or at any event occurring off the premises. Lundstrum Performing Arts is not responsible for injuries sustained during lessons, workshops or performances.

3. Release and hold harmless the staff, agents, and employees of Lundstrum Performing Arts from all liability to me, my child, my personal representatives, assigns, heirs, and next of kin, against any claim or cause of action which I, or anyone claiming by, through or under me, may at any time have against those hereby released arising out of bodily injury (including death), property damage, loss or theft of articles suffered by me or my child while dancing, singing, acting, performing, at Lundstrum Performing Arts and/or attending any event whether or not held at the premises.

4. Have read and agreed to abide by the Lundstrum Performing Arts policies as amended from time to time.

5. I authorize Lundstrum Performing Arts (LPA) to photograph & videotape me while participating in an LPA program or an LPA field trip. I understand that the photographs and video footage that may be used to publicize the program will always be used in a positive manner. I also understand that all photographs and video footage are the property of LPA.

6. Lundstrum Performing Arts reserves the right to cancel or restructure classes that do not meet minimum enrollment requirements.

7. Lundstrum Performing Arts is not responsible for lost or stolen personal belongings.

8. By signing this document I agree to the release statements listed above.

Contact Information
Your Rights Under GDPR