Student first name

Student surname

School

Date of birth

Gender Gender Male Female Non Binary

Which instrument would the student like to learn?

Instruments already played (if applicable)

Playing standard (if applicable)

Guardian / Carer Title (e.g. Mr, Mrs, Ms etc)

Guardian / Carer First Name

Guardian / Carer Surname

Address (Number and Street)

Address (Area/Estate)

Address (Town/City)

Post Code

Phone number

E-mail address

Emergency contact information

Any relevant medical information

Does the child have any special needs 'SEND'? Does the child have any special needs 'SEND'? Yes No

Declaration Declaration On behalf of the student named above, I apply to MK Music Service for instrumental lessons. I agree to give written notice by the end of the term if lessons are no longer required the following term.

Permission to share data Permission to share data I agree that the information above can be shared with the Milton Keynes Music Co-operative for the purposes of arranging instrumental lessons and emergency contact during lessons should the need arise.

Photographic Consent - Photography, Film and Audio: Milton Keynes Music Service 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 Service 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