ENROLLMENT FORM The Artane School of Music St. David’s Park, Artane Dublin 5. www.artanemusic.ie 01-8318929 artaneband@gmail.com Programme applied for (Please Tick) □ □ □ □ □ □
Artane Band(s) Artane Choir(s) Music Theory Leaving Cert. Music Junior Cert Music Instrument Lessons (Please Specify)
____________________________________ Name of applicant ____________________________________ Date of Birth _____________ Address ____________________________________ ____________________________________ ____________________________________ Parent / Guardian Name(s) ____________________________________ ____________________________________ Primary Email Address ____________________________________ ICE (In Case of Emergency) Numbers 1. __________________________________ 2. __________________________________ Current School ____________________________________ Class (year) ____________________________________
Permissions
contacted for the purposes of giving consent at the time of treatment.
I / We the parent(s) / guardian(s) of
I/We thereby authorise the ASM lead individual(s) to communicate our consent to any treating Medical or Dental practitioner. Please advise of any condition which may require special attention or notification to a first aider ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________
(if under 18 years of age)
____________________________________ Hereby give permission for my/our child to partake in all activities organised by The Artane School of Music (ASM) and its associated ensembles (i.e. lessons and activities) I/We authorise, confirm and agree that the ASM Staff members (the lead individuals) shall have authority over our child and the right to give lawful instructions to our child to the same extent as we ourselves would be able to do so. I/We understand that in the very unlikely event of my/our child requiring medical attention all reasonable efforts will be made to contact me/us at the ICE contacts given above. I/We consent to immediate first aid and/or appropriate treatment being given to my child in the event of an injury/illness while in the care of the staff of the School of Music. In the very unlikely event of my / our child being taken ill or injured during the period of this consent, I/we hereby consent to any emergency medical, surgical or dental treatment required that may be necessary in the event where I/we cannot be
Photographic/Audio/Visual Consent As the Artane School of Music (The Artane Band and its associated ensembles) are constantly in the public eye, it is inevitable and unavoidable that images of the band and its ensembles will be taken However from time to time, it is a requirement that images/audio/visual files taken by ASM staff or agents acting on behalf of ASM (or agents acting on behalf of events in which ASM are participating) will be used for publicity purposes only. This includes publications relating to the School, broadcast media, social media, and on the ASM website.
I/We hereby give permission to ASM for any Photographic/Video/Televisual/Sound files to be used for 1. Documenting and recording or illustrating work processes and events carried out during the School year 2. Artistic work – created and performed by our musicians 3. Reporting to specific interest groups such as evaluators, funding agencies, sponsors and/or the general public 4. Promotional work 5. Any other appropriate use
Signed (Parent/Guardian)
Signed (Parent/Guardian)
If over 18 years of age:
Signed (Student/Member)