Student first name

Student surname

School

Date of birth

Gender

Age

Which project would you like to attend? Which project would you like to attend?Learn Keyboard Monday 19th Dec for children aged 7 - 11Creative Music Making Tuesday 20th Dec for children aged 7 - 11Learn Keyboard Weds 21st Dec for children aged 7 - 11Creative Music for SEN children age 7-16 - Thurs 22nd Dec (parent/carer must also attend)

Do you wish to attend another project? Do you wish to attend another project?NoLearn Keyboard - Monday 19 Dec - age 7-11 (repeat of Weds 21st)Creative Music Making - Tuesday 20 Dec - age 7-11Learn Keyboard - Weds 21 December (repeat of Monday 19th)

Details of child's special needs:

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

Parent / Carer First Name

Parent / Carer Surname

Address (Number and Street)

Address (Area/Estate)

Address (Town/City)

Post Code

Phone number

E-mail address

Any relevant medical information

Emergency contact information

Declaration Declaration If applicable, I confirm that the student named above is entitled to benefit related free school meals and has been provided with a booking code (obtained from school - please insert below)

Booking Code (provided by school) put n/a if not applicable

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