You may be required to attach a direct debit mandate (to the left of this form) or proof of benefit to this application. It is recommended that you have any attachments saved and ready to upload before starting the application.

Privacy Notice under the General Data Protection Regulations

Telford & Wrekin Council are collecting Personal Identifiable Information to process your application. We need to collect this information to process your request. This information is being processed under DPA - Schedule 2 (2a) (GDPR 2018 - article 6 (1)b). Telford and Wrekin will not share any Personal Identifiable Information collected with external organisations unless required to do so by law. For further details on the council's privacy arrangements please view the privacy page on the council's webpage.

Student

Surname *

Forename *

Date of Birth *

Gender

Male
Female

Current School *

Current Year Group

Special Educational Needs/Medical Conditions

No
Yes (please give details below)

Parent/Guardian/Carer

Surname *

Forename *

Address *

Postcode *

Telephone (home)

Work

Mobile

Email *

Obtaining An Instrument

If the pupil is NOT a beginner, for how long have they been learning?

Grade?

Payment and Agreement

I will make payment via: *

Direct debit (please attach mandate to this application)
One-off-payment inclusive of all lessons running until the end of Summer term.
I am entitled to free lessons (please attach proof of benefit)
Direct debit including remission (please attach direct debit mandate & proof of benefit)
One-off payment including remission (please attach proof of benefit)

Please note that the remission of fees cannot be back dated. If your son/daughter has been provided with lessons before proof of benefit has been received then this will not be taken into account.

I have read, understood and agree to the terms & Conditions regarding lessons and instrument hire (as appropriate) described within the application pack. *

Signed: *

Date: *

Notes Please add any additional information here.

Photo Consent

Telford and Wrekin Council frequently uses photos of people in publications and on our website to publicise our services or celebrate special events. These may appear in our printed publications, on our website, or both. We may also send them to the news media. Please note that websites can be viewed throughout the world, not just the United kingdom where UK law applies. Please note that you are entitled to withdraw your consent to our use of the photographs at any time by contacting the Music Service on 01952 380981 / email: Telford.Music@telford.gov.uk

We regularly send publicity material about our services, including photographs, where appropriate, to the media, especially local press. Can we use your child's photograph in this way?

Yes
No

Instrumental/Vocal Lessons Form

Instrumental/Vocal Lessons Form

Price List

Terms & Conditions

Instrument Hire Terms & Conditions

Direct Debit Mandate form

Remission Criteria