Guitar Archives - Richmond Music Trust

Participant Details

Participant's Name*

First Last

Participant's preferred name to be used (if different to that stated above)

Child's gender*

Participant's preferred pronouns

Participant's Date of Birth*

Participant's Current Academic Year (to 31 Aug 2024)*

Participant's Current School (to 31 Aug 2024)*

Participant's Additional Need(s)*

SEN
Allergy
Medical
Accessibility
Other
None

NB please tick any/all that apply and give details in the box provided below. If required we will contact you to discuss further.

Details of any additional need listed above

The Participant is*

new to Richmond Music Trust
already involved with Richmond Music Trust

Please select the name of the ensemble your child would like to attend a Free Trial Session for*

Which instrument will your child play in this ensemble ?*

Please select the Participant's Level*

Beginner
1+ year's tuition

If your child is a beginner, please provide details of their experience e.g. how many terms/what pieces or books they are working on.

The Participant takes grade exams*

Yes
No

The Participant's current grade is

If yes please state the grade you are currently working towards.

The Participant's teacher's name is*

Please tell us if the Participant plays a second instrument

Parent/Carer Details (first emergency contact)

Parent/Carer Name*

First Last

Parent/Carer mobile*

Parent/Carer email*

NB this email address will be used for all communication

Postal Address*

Street Address Address Line 2 Post Code

I confirm that I have legal parental responsibility for the above named child*

Yes
No

I confirm that the Parent/Carer details I have given can be used as the main Emergency Contact Details for the above named child*

Yes
No

Second Emergency Contact Details

Emergency Contact 2 Name*

First Last

Emergency Contact 2 mobile*

Emergency Contact 2 email*

Emergency Contact 2 relationship to child*

Consent

I give consent for the administration of first aid for my child (named above) whilst onsite with RMT*

Yes
No

I give consent for the seeking of professional medical advice for my child (named above) whilst onsite with RMT*

Yes
No

I give consent for the administration of emergency treatment for my child (named above) whilst onsite with RMT*

Yes
No

I give consent for my child to travel alone to and from this ensemble*

Yes
No

I give consent for my child to be photographed/filmed/recorded*

Yes
No
I would like further information before I decide

NB any images and/or recordings, audio or visual, may be used on RMT social media platforms and/or to promote future RMT events

RMT's full Terms & Conditions will apply on acceptance of your child's ensemble place.

I confirm I have read and accept RMT's Terms & Conditions?*

Yes
No

Saturday Centre

Briar Road Centre

Richmond Youth Jazz Band (RYJB)

Register your child for their Free Trial Session

RMT Ensemble Free Trial Session Registration

Participant Details

Parent/Carer Details (first emergency contact)

Second Emergency Contact Details

Consent