SLIGO ACADEMY OF MUSIC 7 Lower The Mall, Sligo 087-6847792 Charity No. CHY 15547 ENROLMENT FORM Student Name (Capitals) ____________________________ Parent/Guardian Name _____________________________ D.O.B.________________ Daytime Tel No. ______________ Address of Fee Payer ________________________________________________________________ Evening Tel. No. __________________Mobile No. __________________Email __________________ Subjects requested – Please circle: Violin Flute Trumpet Piano Junior Cert Viola Oboe French horn Singing Leaving Cert 5th or 6th yr Cello Clarinet Trombone Vocal Ensemble Sinfonietta Double Bass Saxophone Guitar Chamber Music Junior Orchestra Recorder Bassoon Classical Guitar Theory Jazz Orchestra Musical Explorers 1: age 3-4 Musical Explorers 2: age 5-6 Jazz Improvisation Preferred Class Times: Please give as wide a choice as possible. Every effort will be made to accommodate preference – however, no guarantee can be made. Day _______________________________________ Time/s____________________________ Teacher ______________________________ Family circumstances/Learning difficulties ________________________________________ Please note that any information disclosed here will be treated in strict confidence. It is important that the teacher is made aware of any circumstances which could affect your child’s behaviour in class or ability to learn I have read and agree to adhere to the Sligo Academy of Music Regulations. Signed Parent/Guardian _____________________________ Date _______________________ Please note that the Sligo Academy of Music is not responsible for your child outside of lesson time.