Student first name

Student surname

Date of birth

Gender

Choose an instrument from the list Choose an instrument from the listDouble BassFrench HornTubaViolaOboeBassoon

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

Emergency contact information

Any relevant medical information

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

Declaration Declaration On behalf of the student named above, I apply to MK Music Service for membership of the specified activities. I agree to pay fees (if applicable) for the above named student termly and give written notice by the end of the term if lessons are is no longer required the following term.

Terms and conditions Terms and conditions I have read the terms and conditions relating to ensembles and classes and agree to abide by them. Terms and conditions

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