E N R O L M E N T F O R M

Student Name (Capitals) ____________________________	D.O.B. (if under 18)________________

Parent/Guardian Name _____________________________	Tel No. ______________________

Address ________________________________________________________________

Email ____________________________

Please provide a current email address as all communication is via email.

Subjects requested – Please circle:

Violin	Flute	Trumpet	Piano	Leaving Cert 5th Year

Viola	Oboe	French Horn	Singing	Leaving Cert 6th Year

Cello	Clarinet	Trombone	Ukulele	Voice Squad

Double Bass	Saxophone	Guitar	Junior Orchestra	Sinfonietta

Recorder	Bassoon	Jazz Orchestra	Young Jazz Allstars Theory - Grade_______

Harp	Girls Choir(+12) Musical Explorers 1: age 3-4	Musical Explorers 2: age 5-6

Art with Shaza	Instrument Rental Required ______

Preferred Class Times: Please give as wide a choice as possible. Every effort will be made to accommodate preference – however, no guarantee can be made.

Day	_______________________________________	Time/s____________________________

Teacher ______________________________

Family circumstances/Learning difficulties __________________________________________________________

Please note that any information disclosed here will be treated in strict confidence. It is important that the teacher is made aware of any circumstances which could affect your child’s behaviour in class or ability to learn

I have read and agree to adhere to the Sligo Academy of Music Regulations as per the website- www.sligoacademyofmusic.ie. I understand that keeping a photographic record is a regular part of school activities so by signing this form I am giving permission for the taking of such photographs and video.

Signed Parent/Guardian _____________________________	Date _______________________

Please note that the Sligo Academy of Music is not responsible for your child outside of lesson time.