Music Group Application Form – Bradford Music Education Hub

Parent/Carer Name *

First

Last

Pupil Name *

Instrument *

School *

Pupil Date of Birth *//

Pupil Gender *

Ethnicity

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Home Telephone

Mobile/Emergency Tel *

Email *

Ensemble Membership Applied For: *

Date membership is to commence *

Free School Meals then you can apply for free ensemble membership.

My child receives Free School Meals
My child DOES NOT receive Free School Meals

Your child’s school will be contacted to confirm the Free School Meal status and once confirmed the free membership would last for the remainder of that academic year. This would then be reviewed in September each year.

Location of Ensemble *

Do you have a medical condition to declare?

If 'YES' please specify.

I will complete and return a direct debit form *

I understand that by signing this contract I will be liable for termly payments until written or email confirmation is provided of withdrawal. I accept the terms and conditions. *

NB All communication from Music & Arts Service will be via email or text so please ensure this information is accurate.

Please Indicate how you heard about the Music Centre *

Please State Other