Student name

Address

E-mail address

Phone number

Are you submitting this form for yourself? Are you submitting this form for yourself?YesNo

Parent / Carer name

Which ensembles would you like to stop? Which ensembles would you like to stop?End all ensemblesMusic ExplorersMusic MakersMusic CreatorsStart KeyboardStart StringsStart WoodwindBeginner StringsBeginner Wind BandBeginner KeyboardsYoung KeyboardsJunior ChoirJunior StringsJunior Wind BandTraining StringsIntermediate ChoirIntermediate Wind BandIntermediate OrchestraBig BandPercussion WorkshopFlute EnsembleClarinet EnsembleDouble Reed EnsembleYouth BrassString OrchestraProteus StringsElfin StringsKeyboard EnsembleWind OrchestraYouth OrchestraJunior Rock SchoolSenior Rock SchoolAdult Wind Band (Prevailing Wind)Midsummer PlayersOther

Please specify

What is the end-date? What is the end-date?At the end of the Autumn TermAt the end of the Spring TermAt the end of the Summer Term

Please let us know why you/your child no longer wishes to attend

Declaration Declaration On behalf of the student named above, I hereby stop the nominated ensembles as of the end-date specified.