1 April 2017 at Bracknell Music Centre

* 1. Pupil's first name and surname

* 2. Pupil's School

* 3. Pupil's School Year

* 4. Instrument

* 5. Instrumental teacher

* 6. What is your ability?

* 7. Do you belong to any ensembles?

* 8. Parent/carer name

* 9. Parent/carer emergency contact phone number

* 10. Parent/carer email

* 11. Medical conditions/Medication

* 12. We will be taking photographs and video for publicity and marketing during this course. Please confirm whether you are happy for your child to be included in these images which may be posted externally (names not included).

* 13. How did you find out about this course?

* 14. I agree to you using my e-mail address to contact me:

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