Join us June 3rd for a Suzuki Play-In!

I give my consent and approval for my son/daughter to participate in the Lakeland Youth Symphony. By signing this form, I acknowledge that any activity involves potential for injury. Furthermore, I will not hold The Lakeland Youth Symphony, Lakeland Symphony Society, Inc., the Board of Trustees of the Lakeland Symphony Society, Inc., and/or any independent contractor retained by the Lakeland Symphony Society, Inc. responsible in the event of accident or injury resulting from my child’s participation in the Symphony. As Parent and/or Guardian of the above named participant, a minor, I hereby authorize the treatment by a qualified and licensed medical doctor selected by the Lakeland Youth Symphony (Lakeland Symphony Society, Inc.) in the event of a medical emergency which, in the opinion of the attending physician, may endanger my child’s life, cause disfigurement, physical impairment or undue discomfort if delayed. This authority is granted only after reasonable effort has been made to find me. I also guarantee payment of all charges incurred during this medical treatment (physician, hospital, x-ray, lab, drugs, ambulance, etc.). I hereby give my consent that any videotapes, photographs and/or motion pictures film or audio recordings in which my daughter/son appears may be used by The Lakeland Youth Symphony in their flyers, brochures, and ads including their website. (photo only, not name) I also consent to the use of my cell phone number for the purpose of receiving urgent information in text format from the Lakeland Youth Symphony.