Brighton & Hove Music & Arts Summer School 2012

Thank you for applying to our Summer School. Please complete one application form for each course applied for. Acknowledgements of your application will not be sent, but you will be contacted if an audition is required, or if the course selected is full. Course details will be sent to you in June.

Course Title Course Number Course Date

Parent/Carer’s Name (Mr/Mrs/Ms/Other) Parent Email

Applicant’s Forename Surname D.O.B

Address

Postcode Tel No School

Emergency Contact Details Instrument/Voice How Long Learning Grade

Please give details of orchestras/bands/choirs/Music Centre/dance activities of which you are, or have been, a member

Junior Music Theatre – please tick box if applying for solo part audition: □Please give details of any Special Educational Needs/Disability, allergy or medical condition:

Subsidised Course SchemeI wish to apply for an 80% subsidy because I receive: Income support Job Seekers Allowance (income based) Pension Credit ESA (income based)

I wish to apply for a 50% subsidy because I receive: Child Tax Credit (with entitlement to free school lunches) Working Tax Credit (with entitlement to the maximum available)

I am already registered on the Subsidised Tuition Scheme or

I have enclosed a complete copy of my award notice

I enclose cheque no. (made payable to Brighton & Hove City Council) for £

Signature of instrumental teacher (if applicable) Date

This application cannot be accepted without the following signatures:I agree to the applicant being absent from school/college to attend the above courses.

Authorising Signature (School/College) Date

The information you have provided will be used for Music & Arts purposes, but it may be used for other Council purposes, where this is permitted by the law. The Council is registered under the Data Protection Act 1998 for these purposes. The Council is the Data Controller for the purposes of the Data Protection Act 1998. If you want to know more about the information we have about you, or the way we use your information, please write to the Council’s Data Protection Officer, Kings House, Grand Avenue, Hove.

From time to time we may take photographs of activities to use, without names included, in printed council publicity and on our website. If you do not want your child’s photograph used for council publicity, please tick this box: If you do not want your child’s photograph used on the council’s website, please tick this box: Please note that photos are likely to be taken at events open to the public.

I agree to the terms laid out above.

Parent/Guardian Date

Please return application form and cheque to: Brighton & Hove Music & Arts, County Oak Avenue, Brighton BN1 8DJ.Closing date for applications: 1 June 2012. Additional application forms can be downloaded from our website www.bhma.org.uk