Local Music Groups application form

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Applicant's name*
FirstLast
Applicant's email*
Gender*
- Male
- Female
Applicant's contact number*
Applicant's date of birth*
Parent's / Carer's title
Parent's / Carer's name
Parent's / Carer's email
Parent's / Carer's mobile number
Daytime contact number*
Evening contact number*
Address*
Street AddressCityCountyPostcode
Name of School / College*
School address
School Year*
How would you describe your ethnicity?
Do you consider yourself to have a disability?
A disability as defined by the Disability Discrimination Act is defined as "a physical or mental impairment which has a substantial and long-term adverse effect on a person's ability to carry out normal day-to-day activities"
Does the applicant suffer from any known medical condition or allergies?*
- Yes
- No
Please state
Accident or illness*
- Yes
- No
In the event of an accident or illness, I give permission for the applicant to receive any medical attention which may be necessary, including anaesthetic and blood transfusion
Doctor's name
Recording permissions*
- Yes - I do give permission
- No - I do not give permission
Kent Music occasionally takes still photographs and/or video recordings of students in rehearsals or concerts for archive purposes, teacher training and inclusion in our brochures and publicity material. Do you give permission for photos/videos of you / your child to be used by Kent Music for these purposes.
Please complete the following section if the name and address for the invoice is different from above
Name
Invoice address
Street AddressCityCountyPostcode
Thank you for completing your personal information. When you click Next you will be redirected to a new form to complete your application

Local Music Group
Preferred start date*
Instrument played / voice*
Level of achievement on instrument(s)
Other Kent Music groups / projects attended
Kent Music is required by the Data Protection Act to obtain your informed consent to hold your up-to-date details on our database.*
- "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. Kent Music retains this personal data after the student has cancelled the contracted services with Kent Music"

Kent Music

Local Music Groups application form

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