Copy of NSCYM Membership Form: 2016 (WEB) Question Title Question Title * 1. About the young musician.... Young Musicians Full Name Gender (Male/Female) Age Date of Birth School Attended from September 2016 Question Title * 2. We need some contact information for the young musicians family or carers.. Parent or Carer Name Address Line 1 Address Line 2 Address Line 3 Town Post Code Parent or Carer Home Phone Number Parent or Carer Mobile Number Parent or Carer Email Address Question Title * 3. Tell us what the young musician plays... Main instrument Grade, standard or level of main instrument Second instrument if applicable Grade, standard or level of second instrument If already an NSCYM member please tell us what groups they play in Question Title * 4. You need to give us permission (or not) for a few things... Yes No I give permission for photographs/video to be taken of my child for use in NSCYM resources, leaflets, advertising etc. I give permission for photographs/video to be taken of my child for use in NSCYM resources, leaflets, advertising etc. Yes I give permission for photographs/video to be taken of my child for use in NSCYM resources, leaflets, advertising etc. No I give permission for my child's name to be printed in concert programmes. I give permission for my child's name to be printed in concert programmes. Yes I give permission for my child's name to be printed in concert programmes. No I give permission for my email address to be passed to the administrator of the Friends of NSCYM for them to send you their newsletters and updates about fundraising and social activities they organise. I give permission for my email address to be passed to the administrator of the Friends of NSCYM for them to send you their newsletters and updates about fundraising and social activities they organise. Yes I give permission for my email address to be passed to the administrator of the Friends of NSCYM for them to send you their newsletters and updates about fundraising and social activities they organise. No Question Title * 5. In the unlikely event of your child becoming ill during an NSCYM rehearsal or activity we need to know... Any medical conditions or allergies? Name and address of doctor. Your prefered emergency contacts and phone numbers The NSCYM membership fees are for a season of 9 rehearsals, with three seasons a year (autumn - Terms 1 & 2, spring - Terms 3 & 4 and summer - terms 5 & 6). Backwell Saturday Centre £41 per season Clevedon Saturday Centre £46 per season Jazz Orchestra £31 per season School of Pop & Rock £37 per season Backwell Guitar Centre £23 per season All other ensembles £21 per season Families in receipt of benefit are entitled to a 50% reduction in the charge.Families with 3 NSCYM members will be charged for 2, families with 4 members will pay for 2.5.Invoices will be sent to families homes each season. By clicking the Done button at the foot of this form you are enrolling the musician named at the top into the North Somerset Centre for Young Musicians, and agreeing to pay the membership fees.Please also note that like all educational institutions the North Somerset Music Service that operates the NSCYM is required to hold some data on pupils to fulfil its obligations to the Department for Education and Arts Council England. The data provided to these organisations in their annual data collection exercise is anonymised and individual pupils are not identified. Further information about the Data Protection Act can be obtained from www.nsmusic4you.org.uk Pupils, as data subjects, have certain rights under the Data Protection Act, including a general right of access to personal data held on them, with parents exercising this right on their behalf if they are too young to do so themselves. Done