Application for Instrumental Lessons

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Pupil details

Forename *

Surname *

Which school do you go to?

Gender *

Male

Female

Date of Birth *

YYYY

Ethnicity

Parent/Carer details

Title

Forename

Surname

Relationship to pupil

House number / name of road

Town/city

Country

Postal code

Main Email Address

Bill Payer Details

Is the billing name and address the same as the parent/carer details above?

Yes - please go to the 'lesson details' section

No - select this option to enter details

Clear selection

Title

Forename

Surname

Relationship to pupil

Street

Town/city

Country

Postal code

Main telephone number

Alternative telephone number

Lesson Details

Which instrument do you wish to learn

What lesson type would you like? (please see the link above for lesson charges. We recommend group lessons for beginners)

Group lesson

Individual 20 minute lesson

Individual 30 minute lesson

Clear selection

Are you eligible for subsidsed lesson rates? Please see our 'financial assistance for low income families' webpage for full qualifying conditions and how to claim

No - you will be charged at the standard rate

Yes - Level 1 (families with a household income below £16,190)

Yes - Level 2 (families with a household income between £16,190 and £25,000)

Clear selection

Have you had lessons on this instrument before?

Yes

Clear selection

Give the name of the teacher

Standard (grade or piece being learnt)

Instrument Hire

You will need instrument to have lessons. If you are not hiring from us, you will need to make alternative arrangements for hiring/buying a suitable quality instrument.

Do you require instrument hire (subject to availability)? (see our charges page above for the cost of hiring from us)

Yes

Clear selection

If you are requesting hire of a guitar, violin, viola, cello or double bass, please give the following measurement (in centimetres) of the pupil so we can allocate the correct size of instrument:

Guitar, Violin, Viola: distance from shoulder to fingertips Cello or Double Bass: height of pupil - head to heel when standing up

Photography

Slough Music Service occasionally takes photos and audio/video recordings of pupils for archive purposes, teacher training and use in promotional material (inc.internet). Do you give your consent to us using images of your child for these purposes?

Photo consent given

Yes

Clear selection

Mailing List

We would like to send you information relevant to Slough Music Service’s tuition activities and other musical opportunities we offer. Your details will not be passed to any other organisation.

Mailing list opt-in?

Yes

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Please tell us any other information about the pupil we should know

Terms and Conditions

Once you have submitted this form, we will write to you to confirm tuition, and when lessons will start. You have 14 days from the date of this letter to cancel this agreement without incurring any financial obligations. You will receive a termly invoice for lessons - please do not send any payment until you receive an invoice. This is an ongoing agreement. We will assume you wish to continue with lessons until you write to us to tell us otherwise. You will need to give us the amount of notice as described in the full terms and conditions if you wish to cancel this agreement. You must read and accept our full terms and conditions (via the link above) before submitting this form.

Tick here to confirm you have read and accept our terms and conditions

Yes

Please enter your full name

Date

YYYY

Submit

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