Thank you for re-enrolling your child!

Please note: MYCincinnati is only available to children who live and/or go to school in Price Hill. This is inclusive of the following zip codes: 45204, 45205, 45238

Your Name *
Your Name
Mobile Phone
Mobile Phone
Home Phone
Home Phone
It's best to contact me by... *
You can select more than one.
If you are enrolling more than one child, please complete enrollment for each child individually.
Child's Name *
Child's Name
(Example: Mother, Grandfather, Guardian)
Child's Birthdate *
Child's Birthdate
What is your child's phone number?
What is your child's phone number?
If your child has their own phone and you'd like us to be able to contact them directly, please provide their number here.
Who should we contact in case of any emergency?
Who should we contact in case of any emergency?
(Ex. parent, guardian, grandparent, sibling)
What is your child's emergency contact's phone number?
What is your child's emergency contact's phone number?
Please provide full names and phone numbers.
Does your child receive free or reduced lunch?
For funding purposes only, this information will be kept private.
Which of the following opportunites to support MYCIncinnati interest you most?
Select as many options as you like!
By checking this box I agree to the MYCincinnati liability statement below. *
I release and waive, and further agree to indemnify, hold harmless MYCincinnati, Price Hill Will, the individual members, agents, employees and representatives thereof; from and against, any which I, any other parent or guardian, any sibling, the student or any other person may have claim to have, known or unknown, directly or indirectly, for any losses, damages or injuries arising out of, during, or in connection with the student’s participation in the program and related activities or the rendering of emergency medical treatment, if any. In the event of an injury, accident, illness or other emergency, I hereby authorize my child to be treated by emergency personnel as required at the time for health and safety. I agree to accept financial responsibility for the costs related to this medical treatment. All efforts will be made to contact a parent or guardian at the phone number(s) provided before any action is taken.
By checking this box I agree to the MYCincinnati image and likeness release below. *
I hereby grant to Music for Youth in Cincinnati. (“MYCincinnati”) the right to use my name, photograph, likeness, recorded voice, video image and recording, biographical data/story, and/or similar information to advertise, promote, and publicize MYCincinnati. I hereby waive the right to inspect or approve the finished image, videotape, digital recording, sound track, advertising copy or printed matter that may be used or to any eventual use that it might be applied. I also waive the right to compensation. I hereby release any and all claims, demands, damages, and causes of action of any nature that I have or may hereafter have against MYCincinnati, its volunteers, affiliates or agents arising out of or in connection with said use, including, but not limited to, any claims for defamation, invasion of privacy, right of publicity, infliction of emotional distress, negligence, or for any copyright or other property rights. I hereby certify that I am competent to contract in my own name. I have read this Release before signing below and warrant that I fully understand its contents.