Ensemble Application Form

Chosen Ensemble (required)

---Pan-oramicSteel the MagicRitmoElectric Ensemble

Student Name (required)

Date of Birth (required)

Name of School

Instrument(if applicable)

Skill Level(if applicable)

Beginner (Grade 0-3)Intermediate (Grade 4-5)Advanced (Grade 6+)

Please state any Allergies / Medical Conditions / Access Needs

SoundStorm is funded by the Arts Council of England to deliver activity as part of the Bournemouth and Poole Music Education Hub. A condition of this funding is that we gather information on the young people participating in our activities. The additional information we request is for the purposes of reporting alone; it will be reported as numerical data only and will not identify any individual. We will keep all information submitted on an encrypted server and will delete the additional information after 3 years.

Additional Information:

Gender
MaleFemaleOtherPrefer not to say

Eligible for Pupil Premium?
YesNo

Any Special Educational Needs (SEN)?
YesNo

I give permission for my child / ward to take part in the above ensemble (required)
YesNo

Parent Name (required)

Parent Email (required)

SoundStorm occasionally email a tailored newsletter to parents/guardians with musical opportunities that may be of interest to them and their child. Would like to sign up to the SoundStorm parent/guardian newsletter?
YesNo

Parent Phone Number (required)

Alternative Phone Number (in case of emergency)

Address (required)

SoundStorm would like to take photographs and/or film footage of your child/ward participating in the above ensemble for promotional purposes. These images or video footage may appear in the printed publications, website or social media (Facebook, Twitter, Youtube, Vimeo) of SoundStorm. Parents/guardians must give written permission for the use of any photographs or video footage. Young people’s names will not accompany photographs unless we have sought separate permission. Photographs and video footage will be kept for 5 years and then destroyed and not used again.

I consent to SoundStorm using photos or film footage taken during the above ensemble on...

Printed Promotional PublicationsSoundStorm WebsiteSocial Media

Please use this area to ask any questions