PLEASE PRINT LEGIBLY!

STUDENT'S LAST NAME__________________________________________________

STUDENT'S FIRST NAME__________________________________________________

TEACHER ______________________________________________________________

Release Form for all BCAPT activities for the school year 2018-2019

I hereby fully release and forever discharge, on behalf of myself and my child, the Bucks County Association of Piano Teachers, and its members and officers, from any and all claims, including claims for injuries, losses and damages, resulting from, or arising out of, my and /or my child's participation in any Bucks County Association of Piano Teachers' recital, activity and/ or event.

Signature of Parent, or Participant if not a minor                                      Date

PHOTO/VIDEO POLICY:  I agree that BCAPT may take my and/or my child's picture or video at BCAPT programs or events.  Please be aware that these photos are for BCAPT's use and may be used in future brochures, flyers, newspapers, BCAPT website and BCAPT Facebook and/or other social media pages.

Signature of Parent, or Participant if not a minor                                        Date

Print version: Release Form for all BCAPT activities for 2018/2019 :

Please send this form to: Lorrie Ksiazek, 53 Fair Oaks Ct., Newtown, PA 18940