Book Your Place

Please fill in the Booking Form to complete your application.

Philomel Music Academy - Booking Form

STUDENT

First Name

Last Name

Date of Birth

YYYY

Age on 10/7/22

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

Instrument 3

Instrument 3 Grade

Please give any additional information about the student's standard of playing, eg other instruments not listed above or where the standard is below Grade 3, aspirations, achievements etc.

Is there anything else we should know about the student, eg allergies?

Where did you hear about the Philomel Music Academy?

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

Yes

I consent to the 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

COURSE ACCEPTANCE

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

Resident

Non-resident

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

The Philomel Music Academy reserves the right to make any necessary changes to the programme. 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!