As the parent/guardian of _______________________________________ (name of student), a minor receiving individualized music instruction at The Pennsylvania State University School of Music, I understand that my child may be in a room alone with an adult instructor.
The University has conducted background checks for all of its instructors, and diligently sought to minimize the instances of unsupervised contact in accordance with its policies. However, the nature of individualized music lessons is such that one-to-one sessions may be unavoidable.
By signing below, I hereby acknowledge my awareness and understanding that my child may be alone with an adult instructor, and give my consent.
Parent/guardian printed name
Parent/guardian signature Date
Name of teacher _________________________________________