Parent/Guardian full name

Email Address

Telephone number

Child's name

Child's Age

Instrument InstrumentPianoGuitarDrumsViolinTrumpetSingingSaxophoneBass guitarFluteClarinet

How long they have been playing / approximate experience level

What best describes your child’s experience with their instrument? What best describes your child’s experience with their instrument? Total beginner Knows some basics but needs guidance Can play independently and follow songs Experienced, plays with confidence

Availability Availability Thursday Wednesday

Wednesday session Wednesday session 4.30pm-5.30pm (8-10 yrs) 5.30pm-6.30pm (10-13yrs) 6.30pm-7.30pm (14-17yrs )

Thursday sessions Thursday sessions 4.00pm-5.00pm (10-12 yrs) 5.00pm-6.00pm (12-14 yrs) 6.00pm-7.00pm (14-17 yrs)

*Places in all groups are subject to availability. If your preferred group is full, we will do our best to offer a suitable alternative. If there is sufficient demand, we may consider opening an additional group on another day. *Places in all groups are subject to availability. If your preferred group is full, we will do our best to offer a suitable alternative. If there is sufficient demand, we may consider opening an additional group on another day.

Does your child have any medical conditions, allergies, disabilities or SEN that we should be aware of?

Anything else you would like us to know?

Will your child be permitted to travel independently, without an accompanying adult, to and from RockJam workshops at Hornsey Town Hall, The Broadway, Crouch End, London N8 9JJ? Will your child be permitted to travel independently, without an accompanying adult, to and from RockJam workshops at Hornsey Town Hall, The Broadway, Crouch End, London N8 9JJ? Yes, I give permission for my child to travel to and from the RockJam workshop independently. No, my child will be brought to and collected from the RockJam workshop by me or another adult authorised by me

Independent travel permission Independent travel permission I confirm that I am the parent or legal guardian of the child named on this form and give permission for them to travel independently, without an accompanying adult, to and from RockJam workshops at Hornsey Town Hall, The Broadway, Crouch End, London N8 9JJ. I understand that I am responsible for my child's journey to and from RockJam outside the time they are under the Tutor's supervision.

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RockJam Workshops Terms and Conditions (opens in a new tab) RockJam Workshops Terms and Conditions (opens in a new tab) I confirm that I have read and agree to the HHMS RockJam Parent Terms & Conditions.