ACG Youth Ensembles Registration Form Student Name* First Last Parent Name* First Last Student Email* Parent Email* Parent Phone Number*Do you play any other instruments?*Would you like to make a Donation? Your gift will support ACG services! Yes, I would like to make a donation. I would like to give a gift of:*$50 - Thank You!$150 - A ‘Normal’ Registration$300 - The Cost of Two Spots!$500 - Support our ServicesOtherAmount: Credit Card* American ExpressDiscoverMasterCardVisa Card # Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Code Cardholder Name Billing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Media Release and Member Agreement* By checking this box, as the parent or guardian of the student listed above, I hereby give Austin Classical Guitar (ACG) and its employees, representatives, and authorized media organizations permission to print, photograph, and record my child for use in audio, video, film, or any other electronic, digital, and printed media. I am aware that I will not receive monetary compensation for my child’s participation, and I release and relieve ACG, its Board of Trustees, employees, and other representatives from any liabilities, known or unknown, arising out of the use of this material. By checking this box, I also indicate that I, and my child, read and agree to the policies set forth in the ACG Ensembles Member Policies and Agreements Form provided to you by your child’s director at the beginning of each session. ACG Newsletter Please sign me up to receive ACG's e-newsletter. NameThis field is for validation purposes and should be left unchanged.
