UNA Woodwind Day

Participant First Name

Participant Last Name

Participant Email Address

Participant Phone

Participant Birthdate

School

Band Director Name

Private teacher name, if applicable

Instrument

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone Number

Are you requesting any accommodations (intellectual, physical, or otherwise)?

Have you attended a UNA Woodwind Day in the past?

Yes

No

How did you hear about UNA Woodwind Day?

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Upload Signed Liability Waiver

Photo Release
I hereby authorize The University of North Alabama and those acting in pursuant to its authority
to:

(a) Record my likeness and voice on a video, audio, photographic, digital,
electronic, or any other medium.
(b) Use my name in connection with these recordings.
(c) Use, reproduce, exhibit, or distribute in any medium (e.g. print publications,
video, CD-ROM, Internet) these recordings for any purpose that the University,
and those acting pursuant to its authority, deem appropriate, including
promotional or advertising efforts.

I release the University and those acting pursuant to its authority from liability for any violation
of any personal or proprietary right I may have in connection with such use. I understand that all
such recordings, in whatever medium, shall remain the property of the University. I have read
and fully understand the terms of this release.

DISCLAIMER: By typing your name below, you are signing this release electronically.