Application Form for Lessons – Bradford Music Education Hub

On-line Application Form

Pupil Name *

Instrument *

School *

Pupil Date of Birth *//

Year Group

Special Needs *

Pupil Gender *

LAC

Ethnicity *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Parent/Carer Name *

First

Last

Payers Address if different from the child's address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Home Telephone

Mobile/Emergency Tel *

Email *

Lesson Type *

For Payment *

How did you hear about lessons?

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.

Checkboxes *

Please tick this box to ensure that you receive additional information about relevant musical opportunities for your child. If you do not tick the box we will still continue to send you information/details relating to this contract, but you will not receive information about additional opportunities (in accordance with Bradford Council GDPR policies).

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