WAIVER AND POLICY STATEMENT
Please read carefully and digitally sign below.
The student listed above has my permission to participate in the Southern Miss Piano Institute Piano Concerto Weekend at the Southern Miss School of Music on the campus of the University of Southern Mississippi. I understand there are risks, and that I participate in this program at my own risk and that The University of Southern Mississippi will not be responsible for any personal injuries, property damage, or related expenses, including but not limited to medical expenses, incurred as a result of my participation in this program. I further agree to indemnify and hold harmless The University of Southern Mississippi and its agents and representatives from any and all liability for any harm, injury, damage, claims, causes of action, and all costs, including attorney’s fees, that may result from, arise out of, occur during, or are in any way connected with my participation in lessons, classes, or other activities of the Southern Miss Piano Institute/Southern Miss School of Music.
I understand and accept the policies of the Southern Miss Piano Institute as stated here and accept responsibility for charges and fees incurred.
I will allow the Southern Miss Piano Institute to use photographs, video, and recordings made at Southern Miss or at Institute functions, involving the student hereby enrolled.
Student’s signature or parent/guardian signature if student is under 18: