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Pupil Full Name *

First Name

Last Name

Pupil Date of Birth *

MM

DD

YYYY

Year Group September 2024 *

What year group will your child be joining in September 2024?

Year 1

Year 2

Year 3

Year 4

Year 5

Year 6

Year 7

Year 8

Year 9

Year 10

Year 11

Year 12

Year 13

Adult

How Many Instruments? *

Would you like to set up lessons on 1 or 2 instruments? The lesson fees detailed in your letter will be charged twice if opting for 2.

1 Instrument

2 Instruments

Instrument Choice - Lesson 1 *

Alto Saxophone

Bass Guitar

Cello

Clarinet

Drums

Euphonium

Flute

French Horn

Guitar

Oboe

Piano

Recorder

Singing

Tenor Horn

Trombone

Trumpet

Ukulele

Viola

Violin

Instrument Choice - Lesson 2

If applicable.

Alto Saxophone

Bass Guitar

Cello

Clarinet

Drums

Euphonium

Flute

French Horn

Guitar

Oboe

Piano

Recorder

Singing

Tenor Horn

Trombone

Trumpet

Ukulele

Viola

Violin

Medical Condition *

Does your child have a diagnosed medical condition?

Yes

No

Media Consent *

Do you consent to your child being included in photo and video footage that will be used to share on our official website, Instagram and YouTube channels? Please note that we will not disclose the identity of any child without express permission. We also do not use or post media captured of lessons or children on personal accounts. On completion of our form, you will be given links to our channels that you are welcome to subscribe to.

YES - I CONSENT

NO - I DO NOT CONSENT

Parental Agreement *

Please confirm that you are happy to sign a parental agreement which lays out clearly the terms of lessons and your commitment to a whole academic year.

YES - I ACCEPT

Payment Terms *

Please confirm that you accept our terms of payment: Autumn Term Lessons - By 30th September 2024 Spring Term Lessons - By January 1st 2025 Summer Term Lessons - By April 1st 2025

YES - I ACCEPT PAYMENT TERMS

Preferred Payment Method *

Please select your preferred method of payment. Please note that we do not accept cash or cheque.

Direct Debit

Debit / Credit Card

Bank Transfer

Instrument Loan *

Please confirm if you would like to loan an instrument from us for the 2024-2025 Academic year. The cost of this is £25.00 for the year (non-refundable). Please note we are unable to loan pianos or drum kits.

YES - I WOULD LIKE TO LOAN AN INSTRUMENT

NO - I WOULD NOT LIKE TO LOAN AN INSTRUMENT

Parent / Carer Full Name *

First Name

Last Name

Emergency Contact Number 1 *

(###)

###

####

Emergency Contact Number 2 *

(###)

###

####

Walking Home *

Will your child be allowed to walk home from lessons? This is relevant to children from: Bitterne Park Primary Holy Family Primary Mansel Park Primary Nursling Primary OLSJ Primary Sinclair Primary

YES - HE/SHE CAN WALK HOME

NO - HE/SHE CANNOT WALK HOME

MY CHILD DOES NOT HAVE AFTER SCHOOL LESSONS

Consent *

I confirm that by ticking below, I give my full consent for my child to take part in these lessons for the academic year 2024-2025. I understand the terms of payment and that should I withdraw before the year has ended, I am still liable for the charge of lessons as detailed in the parent agreement that will be sent to me.

YES - I CONSENT