Forename

Surname

Address

Postcode

Email

Telephone

Date of birth

Gender
Male Female

Name/Address of School
If applicable

Details of any special needs or learning difficulties

Preferred lesson venue

Invoice details

Name and address of person(s) to whom all invoice items should be sent, if different from above.

Forename

Surname

Address

Postcode

Telephone (daytime)

Telephone (mobile)

Telephone (evening)

Section two - application for tuition

Are you a beginner?
Yes No

Instrument/Subject

Previous experience
If 'No' please tell us your current playing standard and how long you have been learning. i.e. "Grade 4, 2 years"

Lesson type

Popular lesson packages
G4 lesson package G3 lesson package G2 lesson package ZingZone Other package

Other, please specify

Promotional Code
If you are applying for a promotion please specify the code identifying that promotion here.

Extra information
If there is anything else you would like us to know, please specify here. e.g: other group members names.

Section three - application for instrument hire

Do you wish to hire a Kent Music instrument?
Yes No

Do you have your own instrument?
Yes No

What instrument would you like to hire?

Length of pupil's outstretched arm (cms)
For violin/viola (from armpit to fingertip)

Height of the pupil (cms)
For Cello/Double Bass

If hiring an instrument I agree to

• Pay the appropriate termly hiring fee until I return the instrument to Kent Music Maidstone
• Maintain all instruments and any subsequent replacements in good condition and to pay for all repairs deemed necessary by Kent Music including string replacements after the first term's hire
• Collect the instrument from and return it to Kent Music Maidstone at the beginning and end of the hiring period. If lessons with Kent Music were discontinued, to return it immediately
• Pay the full cost of replacement in the event of loss or irreparable damage
• Contact Keeper of Instruments immediately at Kent Music Maidstone in the event of damage to instrument

Section four - equal opportunities

This section enables Kent Music to contribute statistical information about inclusivity to the LEA and DFES

Is the applicant eligible for free school meals?
Yes No

Ethnicity
British Irish Gypsy Roma Traveller of Irish Heritage Any other white background White & Black Caribbean White & Black African White & Asian Any other mixed background Indian Pakistani Bangladeshi Any other asian background Chinese Caribbean African Any other black background Any other ethnic group

Other ethnic group

I would prefer to withhold this information

Section five - Data protection and declaration

I understand and agree that Kent Music processes the personal data provided by me on this registration form. This includes the organisation of tuition, ensembles, concerts, tours, bursaries and the hire or sale of musical instruments by Kent Music and approved third parties. Kent Music retains this personal data after the student has cancelled the contracted services with Kent Music.

This agreement is governed by English Law - click on the Send button if you wish to be bound by its terms. For a short time, you have the right to cancel under the provisions of The Consumer Protection (Distance Selling) Regulations 2000 and, if you pay by installments, The Consumer Credit Act 1974.

Your declaration
I confirm that I have read and agree to the terms and conditions.