Application for Instrumental & Vocal Lessons - Bradford Music Education Hub

Pupil Name *

School *

Pupil Date of Birth *//

Year Group (As of September 2023) *

Pupil Gender *

Ethnicity *

Looked After Child (LAC)

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

Special Needs *

Special Needs - please specify

Lesson Type *

*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 Choice

Instrument - 3rd Choice

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Title e.g. Mr, Mrs, Miss etc. *

Parent/Carer Name *

First

Last

Relationship to Child *

Payers Address if different from the child's address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Mobile Number *

Emergency Telephone (different to Mobile Number) *

Email *

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.

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).