Application form - Lewisham Music

I am applying for:

Course Name

Young person details

Surname

First name

Date of birth

What gender do you identify as?

Current school

Current school year group

Home address

Postcode

Parent/Carer details

Parent/Carer's name

Email address

Home telephone number

Mobile telephone number

Emergency contact name (must not be same as above)

Emergency contact number

Alternative emergency contact name (must not be same as above)

Alternative emergency contact number

Other details

Does your child have any special needs, medical conditions, allergies or access requirements?

If YES, please give details below:

Do you give permission for your child to leave the after school group / Saturday Centre / holiday course unaccompanied?

How would you describe your child's ethnicity?

At times during lessons, rehearsals and performances we may take photos and/or video footage in which your child could appear. We may feature these in Lewisham Music online publicity, including our website and social media pages, and general print publicity, including programmes and leaflets, and local, national or international press in support of Lewisham Music stories. Do you give consent for photos or videos of your child to be taken and used in the ways described above, now and in the future?

Does your child qualify for Free School Meals?

Is your child a Looked After Child (in care)?

Instrument details

What instrument(s) are played by your child, including voice? In the box below, please list the instruments, the length of time learning and the approximate grade/level of each instrument

Saturday Music Centre choices
You can apply for as many groups as you want, please refer to the Saturday Music Centre page for further information about all groups

What group would your child like to join at the Saturday Music Centre (FIRST CHOICE):

What group would your child like to join at the Saturday Music Centre (SECOND CHOICE):

What group would your child like to join at the Saturday Music Centre (THIRD CHOICE):

What group would your child like to join at the Saturday Music Centre (FOURTH CHOICE):

Individual instrument tuition

What instrument would your child like to learn at the Saturday Music Centre:

If the instrument your child is interested in learning is not listed then please state below (if this is an instrument we can't offer then we may be able to point you in the right direction):

Confirmation

How did you find out about Lewisham Music?

Would you like to be added to the Lewisham Music's mailing list and receive exciting updates from us and our partner organisations, including events, projects, opportunities and news?

We take your privacy very seriously: your personal information will be stored and processed by Lewisham Music in accordance with our Privacy Policy. Lewisham Music will use the information you provide on this form to stay in touch with you and to provide updates relevant to your activities.