NYJO Academy Application 2020 Step 1 of 2 50% Student DetailsName* First Last Date of Birth* DD slash MM slash YYYY Male or Female?* Female Male School* Contact DetailsParent / Carer Name Address Address 1 Address 2 Town County Post Code Email* Enter Email Confirm Email Student Email Enter Email Confirm Email Home Phone Number* Parent / Guardian Mobile Number Instrument DetailsFirst Instrument* Level of achievement*eg. last music exam passed, length of time learning, how confident you are at improvising Second Instrument Level of achievementeg. last music exam passed, length of time learning, how confident you are at improvising Instrumental Teachers Medical and Emergency DetailsEmergency Contact Telephone 1* Relationship to Student* Emergency Contact Telephone 2 Relationship to Student Family Doctor Telephone Family Doctor Name Does your child have any medical condition, allergies or recent illness we should know about? Yes No Please give brief details and describe any medication requiredIs there anything else you'd like to make NYJO Academy staff aware of? Yes No Please give details Declarations and ConsentPhotography Consent*We plan to take photos and/or videos for promotional use by Cumbria Music Hub and our parters NYJO. No players will be identified by name. I agree to the above I do not agree to the above HiddenDeclarationI have read the details of the course and consent to my son or daughter attending. I agree to his or her participation in the activities involved. I acknowledge the need for obedience and responsible behaviour on his/ her part. I consent to my son/ daughter receiving medical attention as instructed and any emergency dental, medical or surgical treatment, including anaesthetic or blood transfusion, as considered necessary by the medical authorities present. I confirm that the contact details given above are to be used in the event of an emergency or in the event of my son/ daughter being returned home for some other legitimate reason and that at least one of the named contacts will be available throughout the duration of the course. I agree to the above Contact Permission*We may occasionally want to get in touch by email to let you know about events organised by Cumbria Music Hub. Yes please, I'd like to hear about Cumbria Music Hub events No thanks Δ