Enrol - Peninsula Youth Music Society

What program would you like to enrol in?*
Please indicate (✓) which group(s) you wish to join.*
- RHYTHM 'n' BEAT
- BIRRELL STRING ORCHESTRA
- MOVEMENT & DANCE
- START UP STRING
- VOCAL: MUSIC THEATRE
- PERCUSSIVE BEAT
- CONCERT BAND
- CONYERS STRING ORCHESTRA
- STAGE BAND
Please indicate which group you wish to join
- Prep - 3 Program
- 4 - 6 Program
Child First Name
Child Last Name
Date of Birth*
Date Format: DD slash MM slash YYYY
School Grade
Instrument played and standard/grade:
Parent / Guardian's First Name
Parent / Guardian's Last Name
Email*
Phone
Street Address
City
State
Postcode
How did you hear about us?*
The following information is intended to assist in the case of any medical emergency with your child. All information is held in strict confidence.
Emergency Contact Full Name
Emergency Contact Phone
Family Doctor Full Name
Family Doctor Phone
Ambulance Cover
- Yes
- No
Does your child have any medical conditions?
- Yes
- No
If yes, please specify
Terms and Conditions*
- I give my permission for this child to attend the Peninsula Youth Orchestra. In the event of illness or accident I authorise the convenors of the Peninsula Youth Music Society to consent, where it is impracticable to communicate with me, for my child to receive such medical or surgical treatment as may be deemed necessary. I will bear the cost of any such treatment.
Terms and Conditions*
- I give my permission for this child to attend the Peninsula Youth Music Society’s Saturday Morning Music School. In the event of illness or accident I authorise the convenors of the Peninsula Youth Music Society to consent, where it is impracticable to communicate with me, for my child to receive such medical or surgical treatment as may be deemed necessary. I will bear the cost of any such treatment.
Terms and Conditions*
- I give my permission for this child to attend the Peninsula Youth Music Society’s Summer Music School. In the event of illness or accident I authorise the convenors of the Peninsula Youth Music Society to consent, where it is impracticable to communicate with me, for my child to receive such medical or surgical treatment as may be deemed necessary. I will bear the cost of any such treatment.
Photo Release
- I give permission for photos of my child to be used in PYMS print and online
Photo Release
- I give permission for photos of my child to be used in group souvenir photo
Name
This field is for validation purposes and should be left unchanged.