INSTRUMENT HIRE

Parent/Carer Details

Title Mr Mrs Miss Ms Dr Prof Other

Other title

If title is 'other' then please enter title here.

First name *

Surname *

Is your child a West Sussex Music pupil? * Yes No

West Sussex Music Account Number (optional)

Address *

Preferred phone number *

Email address *

A copy of your form submission will be sent to this email address.

Student Details

First name *

Surname *

Gender * Male Female

Date of birth *

DD/MM/YYYY.

School currently attended *

Town of current school *

Does the student receive benefits related free school meals? * Yes No

Is the student currently in care? * Yes No

Musical Details

What type of instrument hire are you applying for? * A replacement instrument Instrument hire for West Sussex Music Lessons Instrument hire for non West Sussex Music lessons Instrument hire for Time4Music lessons Instrument hire for a whole-class school programme Instrument loan for use in a West Sussex Music Centre ensemble

Instrument * Baritone Bass Guitar Bassoon Cello Clarinet Cornet Double Bass Drum Kit Euphonium Fife Flute French Horn Guitar Keyboard Oboe Percussion Piano Recorder Saxophone Singing Tenor Horn Trombone Trumpet Tuba Ukulele Viola Violin

Instrument size (where applicable - seek guidance from your teacher)

Instrument hire - Replacement instrument * Yes No

Name of West Sussex Music Teacher *

Regulation and Conditions

Conditions of hire * Tick to confirm agreement

Data Protection

Please tick to confirm that you have read our Data Protection Policy (GDPR 2018) * 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 have read the Privacy Notice.

Declaration

You 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 I am the parent/carer of the child named in this application and that I am over 18 years of age.

IMPORTANT: To avoid our messages going in to your junk folder please add music@westsussexmusic.co.uk to your email address book.

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