Student first name

Student surname

Date of birth

School

Parent / Carer title (Mr, Mrs etc)

Parent / Carer first name

Parent / Carer surname

Phone number

E-mail address

Instrument

Grade

Any medical details we should be aware of

Emergency contact 1 (name & tel no)

Emergency contact 2 (name and tel no)

Confirmation Confirmation By submitting this form you agree to attend both rehearsals and the performance as detailed above.

Photographic consent Photographic consent I have completed the online photo consent form or have completed and submitted a form previously. Online Photo Consent Form