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THE DEADLINE FOR APPLICATIONS IS FRIDAY 10 FEBRUARY
PLEASE RETURN THE FORM TO:
EMAIL [email protected]
POST LEWISHAM MUSIC SERVICE, 3RD FLOOR LAURENCE HOUSE, CATFORD, SE6 4RU
PLEASE CONTACT LEWISHAM MUSIC SERVICE ON 020 8314 3813 TO ARRANGE PAYMENT
PLACES ARE LIMITED AND WILL BE ALLOCATED ON A FIRST COME FIRST SERVED BASIS
LEWISHAM JUNIOR ORCHESTRA
THURSDAY 16 FEBRUARY
CHILD’S NAME DATE OF BIRTH GENDER
MALE / FEMALE
CURRENT SCHOOL CURRENT YEAR
GROUP HOME ADDRESS
POSTCODE
PARENT/CARER NAME EMAIL ADDRESS
HOME TELEPHONE NUMBER MOBILE TELEPHONE NUMBER
EMERGENCY CONTACT NAME EMERGENCY CONTACT NUMBER
IS YOUR CHILD A LOOKED AFTER CHILD (IN CARE)? DOES THE CHILD RECEIVE FREE SCHOOL MEALS?
YES / NO YES / NO
DOES YOUR CHILD HAVE ANY MEDICAL
CONDITIONS? DOES YOUR CHILD HAVE ANY SPECIAL NEEDS?
YES / NO YES / NO
IF YES, PLEASE GIVE DETAILS:
IF YES, PLEASE GIVE DETAILS:
WHAT IS YOUR CHILD’S ETHNIC ORIGIN?
DO YOU GIVE CONSENT FOR PHOTOS OR VIDEOS OF
YOUR CHILD TO BE TAKEN AND USED FOR THE PURPOSES
OF PUBLICITY, NOW AND IN THE FUTURE?
YES / NO
DO YOU GIVE PERMISSION FOR YOUR CHILD TO LEAVE THE LEWISHAM JUNIOR ORCHESTRA UNACCOMPANIED?
YES / NO
WHAT INSTRUMENT DOES YOUR CHILD PLAY? WHAT GRADE/LEVEL IS YOUR CHILD?
1 / 2-4 / 4-5 / 5+
