ENROLLMENT FORM The Artane School of Music St. David’s Park, Artane Dublin 5. www.artanemusic.ie 01-8318929 artaneband@gmail.com

Programme applied for

(Please Tick)

□ Artane Band(s)

□ Artane Choir(s)

□ Music Theory

□ Leaving Cert. Music

□ Junior Cert Music

□ Instrument Lessons (Please Specify)

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Name of applicant

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Date of Birth _____________

Address

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Parent / Guardian Name(s)

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Primary Email Address

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ICE (In Case of Emergency) Numbers

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2. __________________________________

Current School

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Class (year)

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Permissions (if under 18 years of age)

I / We the parent(s) / guardian(s) of

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Hereby give permission for my/our

child to partake in all activities

organised by The Artane School of

Music (ASM) and its associated

ensembles (i.e. lessons and activities)

I/We authorise, confirm and agree

that the ASM Staff members (the lead

individuals) shall have authority over

our child and the right to give lawful

instructions to our child to the same

extent as we ourselves would be able

to do so.

I/We understand that in the very

unlikely event of my/our child

requiring medical attention all

reasonable efforts will be made to

contact me/us at the ICE contacts

given above. I/We consent to

immediate first aid and/or

appropriate treatment being given to

my child in the event of an

injury/illness while in the care of the

staff of the School of Music.

In the very unlikely event of my / our

child being taken ill or injured during

the period of this consent, I/we

hereby consent to any emergency

medical, surgical or dental treatment

required that may be necessary in

the event where I/we cannot be

contacted for the purposes of giving

consent at the time of treatment.

I/We thereby authorise the ASM lead

individual(s) to communicate our

consent to any treating Medical or

Dental practitioner. Please advise of

any condition which may require

special attention or notification to a

first aider

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Photographic/Audio/Visual

Consent

As the Artane School of Music (The

Artane Band and its associated

ensembles) are constantly in the

public eye, it is inevitable and

unavoidable that images of the band

and its ensembles will be taken

However from time to time, it is a

requirement that images/audio/visual

files taken by ASM staff or agents

acting on behalf of ASM (or agents

acting on behalf of events in which

ASM are participating) will be used for

publicity purposes only.

This includes publications relating to

the School, broadcast media, social

media, and on the ASM website.

I/We hereby give permission to ASM

for any Photographic/Video/Tele-

visual/Sound files to be used for

1. Documenting and recording or

illustrating work processes and events

carried out during the School year

2. Artistic work – created and

performed by our musicians

3. Reporting to specific interest

groups such as evaluators, funding

agencies, sponsors and/or the

general public

4. Promotional work

5. Any other appropriate use

Signed (Parent/Guardian)

Signed (Parent/Guardian)

If over 18 years of age:

Signed (Student/Member)