Student Details

First name*:

Middle name:

Surname*:

Date of birth*:

Postal address*:

Parent/Carer Details

First name and surname*:

Relationship to student*:

Postal address*:

Email*:

Mobile phone number*:

ABRSM number (if known):

Musicianship Classes

Please select from the list below:
—Please choose an option—NoneNurseryReceptionYear 1Year 2 (compulsory if learning an instrument)

Instrumental Lessons

The only available instruments for children in Year 2 are piano, violin, viola, cello, harp, piano, singing or drum kit.

Please note that Year 2 musicianship is compulsory if learning an instrument in Year 2 - please select this from the Musicianship Classes above.

Other instruments are available from Year 3, depending on a number of factors including size.

Please select an instrument from the list below*:
—Please choose an option—NoneBassoon including Mini-BassoonCelloClarinetDrum Kit and PercussionFluteFrench hornGuitarHarpOboePianoRecorderSaxophoneSingingTromboneTrumpetViolaViolin

Please select a second instrument from the list below:
—Please choose an option—NoneBassoon including Mini-BassoonCelloClarinetDrum Kit and PercussionFluteFrench hornGuitarHarpOboePianoRecorderSaxophoneSingingTromboneTrumpetViolaViolin

Please indicate your preferred length of lesson*:
—Please choose an option—None30 minutes40 minutes50 minutes60 minutes

Music Theory

Please select from the list below:
—Please choose an option—NoneMusic Theory

Ensembles

Please select from the list below:
—Please choose an option—NoneGuitarHarpRecorderStringWind

GCSE/A-Level Support (minimum 40 minute lesson)

Please select from the list below:
—Please choose an option—NoneGCSE supportA-Level support

I give permission for my child's photo to be used for TLSMC publicity?*:
YesNo

Does your child have any allergies*:
YesNo

If ‘Yes’ please give details below:

Please provide any other relevant information:

How did you hear about us?*:

Terms & Conditions

Please tick the box to agree to the Terms and Conditions*: Yes

Privacy Statement/Data Protection

In accordance with the Data Protection Act 2018, the information that you have provided on this form to 'The Latymer Saturday Music Centre CIC' will be used in the following ways:

• To store it securely either electronically or in paper form

• To use it for the purpose of providing music classes

• To communicate with you as a customer of 'The Latymer Saturday Music Centre' by email, post or phone about your child's classes

• To share with employees/representatives of ‘The Latymer Saturday Music Centre CIC’

I consent to my data being used for the purposes as detailed above.

Please tick the box to give your permission*: Yes

Please tick the box to agree to the Privacy Policy*: Yes

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