For further information on our pricing, please click here Pupil Name *School *Pupil Date of Birth *DD12345678910111213141516171819202122232425262728293031/MM123456789101112/YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Year Group (As of September 2023) *Pupil Gender *Please SelectFemaleMaleEthnicity *Please SelectBlack AfricanBlack CaribbeanBlack OtherBangladeshiChineseIndianPakistaniOther AsianWhiteOther/Prefer not to sayLooked After Child (LAC)Please SelectNoYesOnly select ‘yes’ if child does not live with birth parentsSpecial Needs *Please SelectYes - please specify belowNoSpecial Needs - please specifyLesson Type *Please SelectGroup Tuition (£63 per term)Individual Tuition (£171 per term)*Please note that if you are applying for piano lessons, this is only offered on an individual tuition basis.Instrument - 1st Choice **PLEASE NOTE: IF YOUR CHILD IS ONLY INTERESTED IN ONE INSTRUMENT, DO NOT COMPLETE THE SECOND AND THIRD CHOICES.Instrument - 2nd ChoiceInstrument - 3rd ChoiceAddress *Address Line 1Address Line 2CityState / Province / RegionPostal CodePlease SelectAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAscension IslandAustraliaAustriaAzerbaijan)BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCanary IslandsCape VerdeCaribbean NetherlandsCayman IslandsCentral African RepublicCeuta and MelillaChad ChileChinaChristmas IslandClipperton IslandCocos (Keeling) IslandsColombiaComorosCongo (DRC)Congo (Republic)Cook IslandsCosta RicaCôte d’IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmark (Danmark)Diego GarciaDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial Guinea EritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard & McDonald IslandsHondurasHong Kong)HungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstan)KenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedonia (FYROM)MadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritius)MayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorth KoreaNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin Saint Pierre and MiquelonSamoaSan MarinoSão Tomé and PríncipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia & South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSt. Vincent & GrenadinesSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluU.S. Outlying IslandsU.S. Virgin IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabweCountryTitle e.g. Mr, Mrs, Miss etc. *Parent/Carer Name *FirstLastRelationship to Child *Payers Address if different from the child's addressAddress Line 1Address Line 2CityState / Province / RegionPostal CodePlease SelectAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAscension IslandAustraliaAustriaAzerbaijan)BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCanary IslandsCape VerdeCaribbean NetherlandsCayman IslandsCentral African RepublicCeuta and MelillaChad ChileChinaChristmas IslandClipperton IslandCocos (Keeling) IslandsColombiaComorosCongo (DRC)Congo (Republic)Cook IslandsCosta RicaCôte d’IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmark (Danmark)Diego GarciaDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial Guinea EritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard & McDonald IslandsHondurasHong Kong)HungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstan)KenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedonia (FYROM)MadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritius)MayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorth KoreaNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin Saint Pierre and MiquelonSamoaSan MarinoSão Tomé and PríncipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia & South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSt. Vincent & GrenadinesSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluU.S. Outlying IslandsU.S. Virgin IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabweCountryMobile Number *Emergency Telephone (different to Mobile Number) *Email *How did you hear about lessons? *Please SelectFacebookFriendsInstagramMusic demonstration in schoolSchool (leaflet)TwitterWebsiteOtherI 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. *Please SelectYesNoNon-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.Additional Information: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).EmailSubmit Music Lessons Terms & Conditions