Student Surname (as it appears on a birth certificate or passport)

Student First Name (as it appears on a birth certificate or passport)

Student Date of Birth

Home Address

Home Phone Number

Current School

Parent / Caregiver Name

Parent/ Caregiver Mobile

Parent/ Caregiver Email Address

First Instrument (or voice)

Level Achieved

Second Instrument(s)

Level Achieved

Music Groups/Activities (Current and Past)

Other Information