Weekly Program Form To apply for our weekly programs, please complete the on-line form below. Alternatively, you can download a 2013 weekly application form and send the completed form to: Young Music Society PO BOX 5146 Braddon, ACT 2612 Family Name Your Email (required) Family ID (if known) Postal Address Child's Information Child's Name Date of Birth School Year in 2013 Gender MaleFemale Please provide details on any medical problems, allergies, current medications or known behavioural issues Musical Instruments learnt Weekly program(s) applying for Concert Band Wind Ensemble Jazz Band Boys Choir 1st Parent / contact Name 1st Parent / contact work phone number 1st Parent / contact home phone number 1st Parent / contact mobile phone number Second parent contact details Contact details for your Family Doctor Name Phone Number Address By checking this box, I give permission for my child to attend YMS Weekly Programs. I give permission for the YMS staff or YMS Committee to take any action considered necessary in case of an emergency including physical restraint if necessary. I undertake to pay any medical costs, including ambulance charges, which may be incurred. I dodo not give permission for my child to be given panadol I dodo not give permission for my child to be photographed for the purpose of publicity fort he Young Music Society Additional Comments (optional) Prove you're not a robot!