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City of Leeds Youth Music Groups Enrolment and Application Form 2018-19 ALL New and Returning Members of All CLYM Groups Please Complete ALL Sections

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City of Leeds Youth Music Groups Enrolment and Application Form 2018-19 ALL New and Returning Members of All CLYM Groups Please Complete ALL Sections City of Leeds Youth Music Groups Enrolment and Application Form 2018-19 ALL new and returning members of all CLYM groups please complete ALL sections. Return to: ArtForms Music, Pudsey Civic Hall, Dawson’s Corner, Pudsey LS28 5TA / [email protected] Personal details Please provide complete and accurate information and inform us of any changes. Communication regarding CLYM groups will usually be via email or text. Member’s name________________________________ Parent / Carer’s name ____________________________ Date of Birth DD / MM / YYYY Home address __________________________________ Gender Male / Female _______________________________________________ Member’s email (optional)________________________ Postcode_______________________________________ Member’s mobile (optional) ______________________ Instrument(s) in CLYM group______________________ Home phone ___________________________________ Grade or approx. standard________________________ Parent mobile __________________________________ School / College _________________________________ Emergency contact name and number (if different) Year group in Sept. 2018 _________________________ ______________________________________________ Medical/SEN ___________________________________ Parent email ___________________________________ Dietary ________________________________________ Arts Council England monitoring Please complete, we need this information to secure future funding Do you receive instrumental / vocal lessons at school? (please circle) Yes / No If No, where do you go for lessons? ___________________________________ Are your instrumental / vocal lessons (please circle): individual / group Group(s) you wish to attend (NB groups subject to change according to demand) Junior Groups Date intending to join for 2018/19: Leeds Schools’ Choir September 2018 ☐ Other ☐ DD / MM / YYYY Leeds Schools’ Brass Band Leeds Schools’ String Orchestra Advanced Groups Leeds Youth Percussion Ensemble City of Leeds Youth Orchestra City of Leeds Youth Wind Orchestra Intermediate Groups Leeds Youth Jazz-Rock Orchestra City of Leeds Youth Training Orchestra Leeds Silver Steel Sparrows City of Leeds Youth Training Wind Orchestra Roots Alive – Youth Folk Group Leeds Youth Choir Ensembles run by our Partners with support from Leeds Music Education Partnership Leeds Youth Opera For further information and to apply, visit Leeds Youth Opera’s website www.leedsyouthopera.org.uk or email [email protected]. The Beat Team Ensemble For further information or to register your interest please visit www.djschooluk.org.uk or email [email protected] ArtForms Music, Leeds City Council (Children and Families), Pudsey Civic Hall, Dawson’s Corner, Pudsey LS28 5TA www.artformsleeds.co.uk | Tel: 0113 378 2850 | Fax: 0113 336 7247 | [email protected] Annual Fees and Payment 2018/19 Junior groups £90 Intermediate and Advanced groups £150 (4th group or more is free) Please do not enclose payment: information about payment options will be provided prior to the start of term in September 2018. Names of group[s] applied for: Total Number of junior groups: ____ x £ £ Number of intermediate / advanced groups: ____ x £ £ Please tick the appropriate box if any of the following circumstances apply: (we may need to contact you for verification) Member attends Saturday Music School at Leeds College of Music (and is therefore entitled to free membership of one CLYM group) Member is a Max Card holder (and is therefore entitled to free membership of one CLYM group) We wish to request a Financial Assistance Application Form (Subject to availability of funding, Leeds Music Education Partnership may offer a bursary of two thirds of the membership fee, up to a maximum of £100, to members resident in, or attending an eligible school within, Leeds Metropolitan Area; discretionary fee waivers may also be available.) TOTAL TO PAY £ (NB Please inform us immediately if, once you have returned this form, your child decides not to continue with a CLYM group - otherwise you will be invoiced for their membership) Permission to photograph or film your child From time to time we may film or take photos of the members of our Youth Music Groups, to use for publicity or fundraising. We would like your permission to use any images taken of your child. You can withdraw your consent at any time by contacting us. Please tick all categories for which you give consent – if a box is left blank we will assume consent is withheld. I give permission for Leeds City Council to use images of my child in: Publicity leaflets, booklets or other printed publications Promotional films Authorised websites and social media News media and/or press releases Signatures Parent / Carer’s Signature (Essential) ______________________________ Date (Essential) DD / MM / YYYY Member’s signature (if over 12 years old) ______________________________________________________ Data Protection Act 1998 & General Data Protection Regulation By signing this form, you are consenting to Leeds City Council using the information to process your application for membership of CLYM. Your information will not be disclosed outside Leeds City Council organisation without your consent, except where we are required to do so by law. LMEP is required to submit anonymised data to Arts Council England and will ensure compliance, in line with Leeds City Council’s obligations under the Data Protection Act 1998 and the General Data Protection Regulation. Further information on how Leeds City Council process your information can be found at https://www.leeds.gov.uk/opendata/data-protection-act-1998 ArtForms Music, Leeds City Council (Children and Families), Pudsey Civic Hall, Dawson’s Corner, Pudsey LS28 5TA www.artformsleeds.co.uk | Tel: 0113 378 2850 | Fax: 0113 336 7247 | [email protected] .
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