Student first name

Student surname name

Date of birth

Gender

Parent / Carer first name

Parent / Carer surname

Phone number

E-mail address

Instrument

Grade

Member of: Member of: Youth Orchestra Wind Orchestra Both Youth & Wind Orchestra

Any medical details we should be aware of

Confirmation Confirmation By submitting this form you are applying for a place on the trip to Belgium, departing on 23 July 2023. You confirm you agree to be invoiced £100 which is a NON-RETURNABLE deposit against the total cost of the trip (Estimated to be £550 to £600). We are not able to provide a refund or credit should your child not attend the tour unless we are able to fill the place. You agree to pay the total cost which will be payable in instalments and invoiced monthly, starting September 2022 (see payment schedule in information letter).

Photographic Consent - Photography, Film and Audio: Milton Keynes Music Hub is part of MK Council and occasionally uses photography for publicity purposes. We would like your permission to photograph/film/record audio of your child for possible inclusion in promotional material, website and other publicity material including social media. We will ensure as far as possible that the images/video/audio are not used inappropriately but by submitting this permission form you accept that should this happen, the council does not accept responsibility. Your contact details will remain strictly confidential. Photographic Consent - Photography, Film and Audio: Milton Keynes Music Hub is part of MK Council and occasionally uses photography for publicity purposes. We would like your permission to photograph/film/record audio of your child for possible inclusion in promotional material, website and other publicity material including social media. We will ensure as far as possible that the images/video/audio are not used inappropriately but by submitting this permission form you accept that should this happen, the council does not accept responsibility. Your contact details will remain strictly confidential. I give photographic consent I do not give photographic consent