LYRIQUESTER ~ Music Activities Consent Form

This consent form is for the participation in creative songwriting sessions with LYRIQUESTER, a musical storytelling company. By signing this form, participants agree to provide LYRIQUESTER with ideas, stories, or poems, either individually or collectively written. LYRIQUESTER will refine these submissions into musical songs. This form may be printed.

**Terms:**

1. LYRIQUESTER retains the copyrights to all songs created from the submissions.
2. The songs will not be used for commercial purposes.
3. The songs will be placed in a private gallery on the lyriquester.com website for delivery and streaming purposes.

**Agreement:**

This agreement is between LYRIQUESTER and________________________________________(name of the Residential Company/Facility). 

________________________________________________________________________________________(please print address of Company/Facility).

_______________________________________________________________________________(best contact: Business Phone/Cell Phone/Email Address).

**Activities Director Signature:**

___________________________________(Signature)_____________________________________________(Print Name)_________________ (Date)

                         **Participant Signatures:**

1. __________________________________

2. __________________________________

3. __________________________________

4. __________________________________

5. __________________________________

6. __________________________________

7. __________________________________

8. __________________________________

9. __________________________________

10. _________________________________

11. _________________________________

12. _________________________________

13. _________________________________

14. _________________________________

15. _________________________________

*Note: If more than 15 participants, additional pages may be printed, attached, and submitted to LYRIQUESTER.*

**Submission:** This form can be emailed to: [email protected] or texted to: 760-716-2457.