West Sussex Youth Orchestras Application Form Step 1 of 4 25% Parent/Carer DetailsName* Title MrMrsMissMs First Last Email Address* Phone Number* Alternative Phone Number Address* Address Address Line 2 City County Post Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Student DetailsName* First Last Gender Male Female Other Date of Birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Year Group from September*Please Select...Year 5Year 6Year 7Year 8Year 9Year 10Year 11Year 12Year 1318+School from September* Special Educational Needs/Disabilities Special Diet Any Medical ConditionsPlease fully disclose all appropriate medical information. Does student receive benefits related school meals?*Please Select...YesNoIs the student currently in care?*Please Select...YesNo Musical DetailsInstrument/voice*Pleast Select...BaritoneBass GuitarBassoonCelloClarinetCornetDouble BassDrum KitEuphoniumFluteFrench HornGuitarOboePercussionPianoSaxophoneSingingTenor HornTromboneTrumpetTubaViolaViolinCurrent standard*Please Select...Grade/Stage 5Grade/Stage 6Grade/Stage 7Grade/Stage 8DiplomaOtherIf other, please specify...* Length of time learningPlease Select...Less than 6 months6 -12 Months1-2 Years3-5 YearsMore than 5 YearsName of Music Teacher* Previous Ensemble Experience*Please identify your most recent/current ensemble experience. If you have chosen School or Other please give further details at the end of this form.Please Select...Area Youth OrchestraArea Youth Concert BandArea Big BandSchool OrchestraOtherIf other, please specify...* I am applying to audition for a place in… Select All West Sussex Youth Choir West Sussex Young Voices - Horsham West Sussex Young Voices - Chichester West Sussex Youth Orchestra West Sussex Youth Wind Orchestra West Sussex Youth Big Band I would like to be considered for a County Ensemble because...*First Audition SubmissionAccepted file types: mp3, mp4, m4a, Max. file size: 10 MB.Second Audition SubmissionAccepted file types: mp3, mp4, m4a, Max. file size: 10 MB. Other DetailsDo you believe you qualify for help in paying fees?If you believe that you are eligible for help in paying fees, please select the criterion which applies to you. Customers applying for help in paying fees will need to complete our form and return it to us along with appropriate evidence. Lessons are unable to start until we have received these documents. Please note that this scheme only covers small group, award and music centre tuition.No, I do not qualify for the SchemeIncome SupportIncome Based Job Seekers AllowanceEmployment and Support AllowanceGuaranteed Element of State Pension CreditChild Tax Only CreditChildren in Care are entitled to recieve free tuitionWhere did you hear about West Sussex Music?If you heard about West Sussex Music from a different source then please enter it in the 'Other source' field. Search engine School or college Advert Recommendation Other If other, please specify... Regulations and Conditions*We want you to know exactly how our service works and why we need yours 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 confirm that I have read the Online Learning Policy Privacy Consent* I confirm that I have read 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 confirm that I have read the Privacy Notice Legal Responsibilities* I confirm that I am the parent/carer of the child named in this application and that I am over 18 years of age. Contact Permission*From time to time, we would like to send you details of relevant musical opportunities for example concerts, excursions, and events or ways to support us which may be of interest to you. Yes, Please No, Thank you Photography Permission*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: Yes, I consent to the use of images of my child No, I do not consent to the use of images of my child EmailThis field is for validation purposes and should be left unchanged. Δ
