Student's Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone *

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Cell Phone

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Composer *

First Name

Last Name

Composer *

First Name

Last Name

Teacher's Name *

First Name

Last Name

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Work Telephone *

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Cell Telephone

(###)

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Signature of Participant/Guardian *

By submitting this application, I declare the following: 1. I agree to use an electronic signature. 2. I have read the rules and requirements of this competition and fully understand them. 3. Where the applicant is a minor, I represent and warrant that I am the parent or legal guardian of the applicant and give my full consent and approval for my child/ward to participate in the Walker Music Competition. 4. I consent and authorize the John Child Walker Competition to capture, use, reproduce, and distribute images, video, and audio recordings of the applicant, including his/her musical performance or quoted statements, for promotional and educational purposes. I agree to waive and release any and all claims related to the use of these images and recordings. 5. I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, AND UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS FOR MYSELF AND THE APPLICANT BY SIGNING IT. I HAVE SIGNED IT FREELY AND WITHOUT INDUCEMENT OR ASSURANCE OF ANY NATURE, AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT PERMITTED BY LAW. I FURTHER AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID, THEN THE REMAINING PORTIONS SHALL CONTINUE IN FULL FORCE AND EFFECT. I ALSO AGREE TO INFORM THE JOHN CHILD WALKER COMPETITION IN A TIMELY MANNER IF ANYTHING IN THIS FORM CHANGES.

By checking this box, I confirm that I have read and agreed to the terms and conditions of the competition.