City of Belfast School of Music
JUNIOR APPLICATION / RE-ENROLMENT 2015-16
SECTION A
Please use BLOCK CAPITALS
Student’s Name ____________________________________________________________
Please insert or attach
a recent passport size
photograph
Home Address _____________________________________________________________
__________________________________________________________________________
_______________________________________________Postcode ___________________
Home telephone : ____________________ Date of Birth
/
/
Please tick Male [ ] Female [ ]
School 2014-15 ______________________________ School 2015-16 ________________________________
Present Year Group 2014-15 (Please circle as appropriate)
P2
P3
P4
P5
P6
Mobile number (Parent/Guardian)_______________________________________________
E-mail address (Parent/Guardian)________________________________________________
Does your child have a medical condition / allergy which we should know about?
Yes [ ] No [ ]
Please detail __________________________________________________________________________
Does your child have any SEN/disabilities which may impact on programmes offered?
Yes [ ] No [ ]
Please detail_____________________________________________________________________________
To be completed by the Parent/Guardian who will be paying the fees
The above student wishes to apply/re-enrol* for admission to the City of Belfast School of Music. *Delete as appropriate
I/We accept the current terms and conditions (see website).
He/she is entitled to free school meals.
Yes [ ] No [ ]
Name (Mr/Mrs/Ms) …………………………………………………………..………………………………………… (Please use BLOCK CAPITALS)
Signature……………………………………………………………………………………………………… Date…………………………………………………….
SECTION B
Details of most recent examinations (if any)
Instrument/Theory
Exam Board eg
ABRSM
Grade
Date of exam
(Month/Year)
Mark or
Results Pending
Please complete the following information, if appropriate:
Instrument...................................................................... Instrumental Teacher....................................................................
How long have you played the instrument? .................................. Do you hire a CBSM instrument [ ] Yes [ ] No
PLEASE COMPLETE BOTH SIDES OF THE FORM
CLOSING DATE SATURDAY 18 APRIL
(Auditions for new applicants will take place in May/June)
JUNIOR APPLICATION / RE-ENROLMENT 2015-16 (Cont’d)
Students name………………………………………………………..…
Postcode…………………………….
SECTION C
Junior Instrumental Groups
Please note that group allocation is dependent on standard and will be determined by the Head of Department
I wish to apply for:
Introductory Strings/Elementary Strings/Junior Strings
(String players Primary 5, 6 and 7)
Introductory Winds/Elementary Winds/Junior Winds
(Wind and Brass players Primary 5, 6 and 7)
Junior Music Centre
(Primary 5 and above)
Saturday Club
(Primary 3 and 4)
Tick as appropriate
Junior Instrumental Lessons
(Do NOT include instrumental lessons taken at your school)
Children who are currently in Primary 3 or above may apply for lessons at CBSM on the following instruments:
Piano, Harp, Classical Guitar, Violin, Viola, ‘Cello, Mini-Bass, Oboe, Bassoon, Trumpet, French Horn, Trombone, Tuba, and
Percussion
I wish to apply/re-enrol for lessons at CBSM on the following instrument(s):
1. .....................................................................................
Are you a complete beginner?
[ ]Yes
[ ]No
2. .....................................................................................
Are you a complete beginner?
[ ]Yes
[ ]No
Junior Aural/Theory Class
I am working towards Grade 2 or above and wish to be timetabled for a shared aural/theory class
[ ]Yes [ ]No
SECTION D (Office use only)
Application received/acknowledged………………………………………..........
Audition: Instrument......................................Date…………………………...Time………………………….......Result……………….........
Audition: Instrument .....................................Date…………………...........Time………………………….......Result……………………….
Timetable
Day
Time
Tutor/Conductor
1
2
Junior Aural/Theory
Group:
City of Belfast School of Music, Fortwilliam Centre, Fortwilliam Park, BELFAST, BT15 4AR
[T] 02890 784200 [E] cbsm.info@belb.co.uk [W] www.cbsm.org.uk