Music centre membership applicationInterested in joining the West Sussex Music team? Step 1 of 3 33% Parent/Carer DetailsName* Prefix DrMissMrMrsMsProf.Rev. First Last Address* Street Address Address Line 2 City County Postcode Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Email Address* Contact Number* Alternative Contact Number I am a UK Taxpayer*Please Select...YesNoPlease gift aid my membership*Please Select...YesNo Student DetailsName* First Last Date of Birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender Male Female Other School currently attended* Year groupSpecial educational needs/disabilities Special diet Any medical conditions?*Please Select...YesNoPlease detail any medical conditions.Instrument/VoicePlease Select...BaritoneBassoonCelloClarinetCornetDouble BassEuphoniumFluteFrench HornGuitar (Acoustic)KeyboardOboePianoSaxophoneTenor HornTromboneTrumpetTubaViolaViolinVoiceLength of time learning*Please Select...6 - 12 months1 - 2 Years2-3 Years3 or more yearsCurrent standard*Please Select...BeginnerPrep, FoundationGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7Grade 8DiplomaOtherMusic Centre ensemble*Please Select...Chichester Youth OrchestraHorsham Elementary Wind Ensemble (Hi5 Winds)West Sussex Junior Wind OrchestraWest Sussex Junior String OrchestraWest Sussex Youth String OrchestraWorthing Youth Concert BandWorthing Youth String OrchestraIf current standard is 'other' then please elaborate. Have you attended a taster session of above group?*Please Select...YesNoDoes pupil receive benefits related free school meals?*Please Select...YesNoIs the student currently in care?*Please Select...YesNo Regulations and Conditions*We want you to know exactly how our service works and why we need your and your child’s details. Please state that you have read and agreed to these terms before you continue. I agree to the Regulations and Conditions Online Learning Policy* I agree to the Online Learning Policy Data Protection Policy* I agree to the Data Protection Policy Privacy Notice*This notice explains why we collect personal information about our customers and how we use it. Please confirm that you have read our privacy notice and understand how we will use your personal information. I agree to the Privacy Notice Photo Consent*Occasionally we would like to record or photograph lessons and performances and will sometimes use these images on our website and in publicity material. At no time will the name of any child be made public. Please indicate your consent for us to use images of your child by selecting one of the following options: Please Select...Yes, I consent to the use of images of my childNo, I do not consent to the use of images of my childYou must be over 18 to apply for our services and you must have legal responsibility for the child named in this application.* I confirm that the above statement is true Where did you hear about West Sussex Music?Your Instrument TeachWord of MouthSocial MediaAdvertOtherIf you heard about West Sussex Music from a different source then please enter it below. Δ
