Texas Lutheran University

Student Information

First Name: *

Last Name: *

Instrument:

Years of Experience:

School: *

Grade: *

Age: *

Promotional Rights:
As a condition of the participation of the above named student, I hereby grant Texas Lutheran University the right to use, for promotional purposes only, any photographs, video or audio recordings of myself or the above named student taken by Texas Lutheran University, its employees or agents, during participation in the Program. I further understand and agree that Texas Lutheran University may use (for marketing purposes) any statements or quotes attributed to me or the above named student in my evaluation of the Program.

I agree to the above statement: *

Parent/Guardian Information

Parent/Guardian First Name: *

Last Name: *

Second Parent/Guardian First Name:

Last Name:

Primary Phone: *

(xxx)xxx-xxxx

Additional Phone:

Primary Email: *

An acknowledgement will be e-mailed to this address.

Additional Email: