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

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 give permission for my child to be given panadol

I give permission for my child to be photographed for the purpose of publicity fort he Young Music Society

Additional Comments (optional)

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