registration request

MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_01CA241E.5BE4A390" This document is a Single File Web Page, also known as a Web Archive file. If you are seeing this message, your browser or editor doesn't support Web Archive files. Please download a browser that supports Web Archive, such as Microsoft Internet Explorer. ------=_NextPart_01CA241E.5BE4A390 Content-Location: file:///C:/EA4BB24E/registration.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" registration request

=

piano4t.co.uk registration request form

STUDENT= S

&n= bsp;

Name:
Birth Date:	Start Date:
Current Grade:
Music I like to listen to / would like to play:
Other instruments I play:
Other learning interests (theory, composition, performance….):

PAR= ENTS /GUARDIANS

Name:

Relationship to Child:
Address:
	Postcode:
Home Phone:	Mobile Phone:
Name:
Relationship to Child:
Address:
	Postcode:
Home Phone:	Mobile Phone:
OTH= ER EMERGENCY CONTACT
Name:	Relationship to Child:
Home Phone:	Mobile Phone:
Your child will only be released to an authorized person listed on this form= (parent/guardian and/or emergency contact)
MED= ICAL INFORMATION
Please give details of any allergies:<= /p>
Please give details of any medical condition I should be aware of:
Regular medication:

AUDIOVISUAL RECORDINGS=

An important part of the learning process is recording your child’s performances of pieces learnt in lessons and at concerts. This recording may be audio or= visual but will not be available to anyone apart from myself and of course the students themselves. In s= ome cases (for example, posture problems at the piano) it can be useful to = take a photo to illustrate the point. Again, these photos are purely for educational use and are destr= oyed once the point has been resolved. If you are happy to agree to this then please sign below, as no = such recordings will be made without your consent.

I consent to Hilary Haworth using photography, audio and /or video record= ing as an aid to the progress of the student:

Signature:

Date:

&n= bsp;

TERMS AND CONDITIONS
I have read and agree to the current Terms and Conditions:
Signature:	Date:

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