Application for Instrumental & Vocal Lessons - Bradford Music Education Hub

Pupil Name *

School *

Pupil Date of Birth *//

Pupil Gender *

Year Group (In September)

Ethnicity *

Looked After Child (LAC)

Only select ‘yes’ if child does not live with birth parents

Special Needs *

Lesson Type *

Instrument - 1st Choice *

Instrument - 2nd Choice *

Instrument - 3rd Choice *

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 *

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. *

Non-payment of any kind which results in lesson/membership being cancelled will incur a £10 admin charge for reinstatement. Any lessons/membership dates missed due to cancellation by the Service in relation to failure to pay within stated times scales will not be made up if lessons/membership are reinstated

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).