Student first name

Student surname

Date of birth

School

School Year Group

Parent / Carer title (Mr, Mrs etc)

Parent / Carer first name

Parent / Carer surname

Phone number

E-mail address

Instrument

Grade

Any medical details 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 confirm you have read the information about the Student Leadership Scheme and agree to attend training and other events as required.

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