SAM Enrolment Form 2023/24
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Surname *
First Name *
Date of Birth *
Parent/Guardian Name *
Phone Number *
Email Address *
Address *
Subjects requested - please mark all instruments/classes/orchestra
Theory Class *
Do you require instrument rental ? *
Preferred Class Times
Please give as wide a choice as possible. Every effort will be made to accommodate preference - however, no guarantee can be made.
Times - Please give as wide a range as possible
Any extra information regarding lesson days/times
Family Circumstances/Learning Difficulties: Please note any information disclosed here will be treated in strict confidence. It is important that the teacher is made aware of any circumstances which could affect your child's behaviour in class or ability to learn.
I have read and agree to adhere to the Sligo Academy of Music Regulations as per the website - *
Photographs/videos may be taken at SAM events. I give permission for photographs and videos of my child taken at SAM related events to be used in the promotion of SAM, including social media. *
Please note that the Sligo Academy of Music is not responsible for your child outside of their scheduled lesson times.
Medical Permission Form
I give Sligo Academy of Music permission to carry out any initial minor First Aid action deemed necessary, before contacting me in the event of an accident. *
Medical History/Relevant Information i.e. Allergies etc
The data provided on our registration and medical permission forms will be used for the purposes of organising SAM classes. Your contact information can be used by the SAM office and class tutor to contact you with any important information regarding your musical education. All forms will be deleted after course completion in line with GDPR.
Signed Parent/Guardian *
Date *
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