- West Sussex Music

Student name(Required)

First Last

Student year group(Required)

Student school(Required)

Student age(Required)

Student gender(Required)

What instrument does this student play?(Required)

Playing ability/Grade(Required)

Instrumental teacher

Student address(Required)

Street Address Address Line 2 City County Postcode

Name of parent / carer(Required)

First Last

Parent / carer email(Required)

Booking confirmation email will be sent to this email address.

Parent phone number(Required)

Use a phone number where we can reach you on the strings day.

Consent(Required)

I confirm that I am the parent / carer and my child is aged 8-18 yrs old

Cost

Price:

Any medical information / special educational needs we need to know about?

Any allergies or dietary requirements?(Required)

Please state none if not applicable.

Photo and video consent(Required)

West Sussex Music may choose to photograph, video or record this event and use your child’s image to raise the profile of our work on our website, social media channels and printed material. The names of children will NOT be made public. Please indicate your consent:

Yes

Total Fee for workshop booking

Credit/Debit Card(Required)

Card Details

Cardholder Name

How did you hear about this event?

Google search

Word of mouth

Through school

Social media

Newsletter

Other

Name

This field is for validation purposes and should be left unchanged.