Junior Bandcamp 2019 Application October Bandcamp Step 1 of 5 20% Your Name* First Last Your Email* SECTION 1: CHILD INFORMATION: PLEASE COMPLETE ONE APPLICATION PER CHILD Child’s Name*Date of Birth Date Format: DD slash MM slash YYYY GenderFemaleMaleSchoolYear Group (School year 2019-2020)Age During CourseFriends you wish to be grouped with (where possible) SECTION 2: INSTRUMENTAL INFORMATION: PLEASE PROVIDE AS MUCH INFORMATION AS POSSIBLE TO ASSIST US IN CURATING THE BEST PROGRAMME FOR YOUR CHILD. IF YOUR CHILD DOESN’T PLAY AN INSTRUMENT YET, PLEASE LEAVE THIS SECTION BLANK. InstrumentTutorYears PlayingGradeInstrument 2TutorYears PlayingGradeInstrument 3TutorYears PlayingGrade SECTION 3: MEDICAL AND CONSENTS: WE HAVE A FULL TIME NURSE ON SITE AT ALL TIME AND AN ADDITIONAL QUALIFIED FIRST AIDER. SUPPLYING US WITH AS MUCH INFORMATION AS POSSIBLE WILL HELP US PREPARE FOR YOUR CHILD’S REQUIREMENTSDoctor’s Surgery Name*Doctor’s NameTelephone NumberDoes your childSuffer from any allergies (including plasters)*YesNoIf so whichCarry any medicines*YesNoIf so whichCarry an Epipen*YesNoIf so whichDo you agree to:A member of staff seeking emergency medical response if necessary*YesNoA member of medical staff/first aider administering first aid care locally, if thought necessary*YesNoA member of staff taking photos of your children for use in the end of week presentation (names of children are not used)*YesNoA member of staff taking photos for our twitter account @musicmakersnot (names of children are not used)*YesNoA member of staff taking photos of your children for use on our website or future promotional materials (names of children are not used)*YesNoPlease list any information about illnesses or medical conditions you wish to share with us SECTION 4: PARENT/NEXT OF KIN INFORMATION:Home Address:*Home Telephone:*Mobile Telephone:Next of Kin name:*Next of Kin telephone 1:*Next of Kin telephone 2Additional contact names and numbers during the day (1 minimum, 2 preferred):*NameTelephone Number 6: FEES AND CONFIRMATION Please note, we unfortunately are unable to accept childcare vouchers as form of payment 6.1: COURSE FEES Course Fees*One child, one weekTotal £ 0.00 Terms and Conditions Please note we do not issue confirmation of places. We recommend checking our website (updated daily) to see if spaces are available. A space on the course will be reserved on the day your form and payment is received. In the unlikely event of the course selling out between the date of submission and payment completion, we will call you straight away to discuss. Cancellation is at the Course Director’s discretion depending on the availability on the course at the time of the cancellation. Please make a note that a full information pack will be sent out via email approximately 2 weeks/10 days prior to the course start date Please check our website for details on our how your data is held.