Session date *

MM

DD

YYYY

Session time *

Group A (12:40- 2:20)

Group B ( 2:30- 4:10)

Student Name *

First Name

Last Name

Parent/ Guardian Name *

First Name

Last Name

Phone *

(###)

###

####

Photography Permission: I allow Lore de Cosio Photography LLC to take pictures of my child during the piano recital. *

Agree

Do Not Agree

Usage Permission for Lore de Cosio Photography LLC and Naomi Iwamoto: I allow Lore de Cosio Photography LLC and Naomi Iwamoto to use these photos for social media, website, promotional material, studio archives and other promotional purposes. *

Agree

Do Not Agree

Date

MM

DD

YYYY