Gloucestershire Academy of Music - Easter Holiday Courses 2019
Please use this form to apply for a place on one of our Easter courses
Please select the course you would like to attend *
Full name of person attending *
Your answer
Date of Birth (dd/mm/yyyy)
Your answer
Gender *
Contact email address *
Your answer
Home address *
Your answer
Contact telephone number *
Your answer
Instrument *
Your answer
Approximate standard of playing *
Other instruments played and standard
Your answer
Instrument teacher *
Your answer
How did you find out about this course? *
Health Information
Do you have any health issues that we should be aware of, including allergies? *
Your answer
Do you have any barriers to learning that we should be aware of? *
Your answer
Emergency contact information
Please provide names and contact numbers for two people who can be contacted in an emergency.
Name and telephone number of emergency contact no. 1 *
Your answer
Name and telephone number of emergency contact no. 2 *
Your answer
Media consent
Photographs/videos of students may be taken during the course that may be used for marketing and promotional purposes by Gloucestershire Academy of Music, including on social media.
Please tick which applies to you: *
Payment and booking
1. Your booking is only confirmed once we have received a completed booking form and deposit payment.
2. If you wish to cancel your booking, written notification (which includes email) must be received as soon as possible.
3. The following charges apply from the date we receive written notice as stated above: a) more than 12 weeks prior to the course: loss of deposit; b) 8 to 12 weeks prior to the course start date: 50% of the cost of the course; c) less than 8 weeks prior to the course: 100% of the cost of the course.
4. We reserve the right to make changes to the course such as changes of named tutors and the location of the course. We will aim to notify you in advance of any changes that are necessary.
5. If for any reason we need to cancel the course we will refund any monies already paid by yourself.

Please tick as applicable: *
Thank you for your booking.
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