Thank you for your interest in enrolling your child in the International Violin Institute! Before we go further, we need your online contact information and consent to our collection, use, and disclosure of personal information from or about your child.

• This includes name, address and other information we and the businesses we work with need to schedule lessons, provide Services, and process payments, as described in our privacy policy.
• By proceeding, you acknowledge that you have read and consented to this privacy policy. You also agree to sign and return the form verifying your consent which we will email to you at the address you provide below.  If you do not consent within a reasonable time, we will delete your online contact information from our records.
• You also acknowledge that you are the parent or legal guardian of a child who is, or may become, enrolled with the International Violin Institute, that you are accessing our website to explore enrollment of your child or to ensure your child receives our services.

[___] I CONSENT

Student Name: ______________________________________________________

Parent/Guardian Name: ______________________________________________

Parent/Guardian Signature: __________________________________________

Date: _____________________

Please email the form verifying my consent to my email address listed below:

_______________________________________________________________________