Book Your Place

Please fill in the Booking Form to complete your application.

PMA Booking Form 2023

STUDENT

First Name

Last Name

Date of Birth

YYYY

Age on 2nd August 2023

Gender

PARENT/GUARDIAN 1

Title (Mr/Mrs/Ms etc)

Full Name

First Name

Last Name

Email - please re-enter

Address

Mobile

PARENT/GUARDIAN 2

Title (Mr/Mrs/Ms etc)

Full Name

First Name

Last Name

Email - please re-enter

Address (if different from above)

Mobile

Standard of Playing

Instrument 1

Instrument 1 Grade

Instrument 2

Instrument 2 Grade

Please give any additional information about the student's standard of playing, eg aspirations, achievements etc.

Does the student have any allergies or take any medications? If yes, please give full details.

Is there anything else we should know about the student?

Where did you hear about Philomel Music Academy?

if you selected "other", please specify below:

I consent to having the student's photograph taken for marketing purposes

Yes

I consent to Philomel Music Academy contacting me about future courses

Yes

I understand that, whilst taking all reasonable precautions, Philomel Music Academy cannot eliminate the risk of transmission of COVID

Yes

My child agrees to behave well during the course and I understand that I will be responsible for paying for any damage to property caused by my child

Yes

COURSE ACCEPTANCE

I confirm that this student will be joining the course as a:

The student has previously attended PMA

PAYMENT

Payment should be made by bank transfer to: Account Name: Pavel Timofeevskiy Account Number: 48575412 Sort Code: 60-83-71 IBAN: GB04SRLG60837148575412 SWIFT/BIC: SRLGGB2L Reference: Student’s Name WITHIN SEVEN DAYS OF SUBMITTING THIS BOOKING FORM Fee to be paid:

TERMS & CONDITIONS

Philomel Music Academy reserves the right to make any necessary changes to the programme. The student is required to behave respectfully at all times. In the event that the student causes damage to property whilst on the course, the parents/guardians agree to reimburse Philomel Music Academy in full. If the course is cancelled as a result of government guidance on COVID, fees will be refunded in full. In the event of a student cancellation for any reason, the following disbursements will apply: - more than 8 weeks from the start date: a 50% refund, less £50 - within 8 weeks of the start date: no refund

I agree to these Terms & Conditions

SIGNATURE

Parent/Guardian

First Name

Last Name

We are looking forward to having you on the course!