This Application Form should be filled out by a Parent or Legal Guardian
About the Applicant
Applicant is applying for*
Applicants First Name*
Applicants Last Name*
Gender*
Date Of Birth*
Month Day Year
Age*
Home Address*
Post Code*
Is there any medical information about the applicant that The M.A should be aware of
Is there any medical information about the applicant that The M.A should be aware of

About the Parent or Legal Guardian
(This information will only be used incase of an emergency)
Title*
Last Name*
First Name
Relation to Applicant*
Address
Same as Applicants*
If different please state
Email*
This will only be used by The M.A. It will not be passed on to third parties.
Contact Number*
Please Choose*
Alternative Number

Alternative Contact
Please give the name of another relative or friend who could be contacted in case or an emergency.
Name
Contact Number
Relation to Applicant

Deposit
To make sure you are serious about applying and becoming a member of The Music Alchemist a 10% deposit is requested at the time of the application. When the applicant has been successful in gaining a position you will be notified on how to complete payment. An applicant is only deemed to have been "accepted" when the payment has been received in full.
The deposit is 10% of one terms fees, £150. If this is your first term or you are participating in any special offer the deposit is still £15 and the final payment is subsidised.

After the application has been received and position availability has been checked in your chosen area and and group you will be required to send the 10% deposit. You can pay by credit or debit card through the secure site of paypal or you can send a cheque.
Declaration of Parent / Legal Guardian
I, the undersigned, am the Parent/Legal Guardian of the Applicant, and declare that the information given in this application is correct and hereby apply for a place for my child at The Music Alchemist Kids Rock / Teen Rock Saturday School. I understand that The Music Alchemist reserves the right to restrict admission at its own discretion. The Personal Data included in this form will be "processed" (as such terms are defined in the Data Protection Act 1998) by The Music Alchemist for the purposes of administration. The Music Alchemist will not disclose this information to third parties for marketing purposes. The Music Alchemist itself may use this information to contact you about new opportunities for the applicant within The M.A.
I agree to give half a term's notice in writing mid - term of my child's intention to leave The Music Alchemist Kids Rock / Teen Rock at the end of that term.
Name*
Relation to Applicant*
Date*
I have read and Understand the above declaration
(please tick)*

Yes
Should be Empty:

About the Applicant

About the Parent or Legal Guardian

Alternative Contact

Deposit

Declaration of Parent / Legal Guardian