Participant first name

Participant surname

Date of birth

School or college

Guardian/Carer title (Mr, Mrs etc)

Guardian/Carer first name

Guardian/Carer surname

Phone number

E-mail address

Full address (include Postcode)

Any medical details we should be aware of?

Any dietary needs 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 are applying for a place at the free music group for the young person detailed in this form and give your consent for their attendance. The music group takes place every fortnight.

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