• Instrument / Class enrolling for *
  Cello Choir Clarinet Drums Fife Flute French Horn Guitar Keyboard Music Basics Year 1 Music Basics Year 2 Music Basics Year 3 Orchestra Recorder Saxophone Trombone Trumpet Violin Ukulele
• Has this student been enrolled in any Saturday Music (PN) classes before this year? * Yes No
• If yes, Which year?
• What instrument?
• Is the student being enrolled for any other Saturday Music (PN) class? * Yes No
• If so, Which class?
  Cello Choir Clarinet Drums Fife Flute French Horn Guitar Keyboard Music Basics Year 1 Music Basics Year 2 Music Basics Year 3 Recorder Saxophone Trombone Trumpet Violin None Ukulele
• Student's Name * First Last
• Gender * Male Female
• Street 1 *
• Street 2
• City *
• Email #1 *
• Confirm Email *
• Email #2
• Phone No (Day Time):e.g”06-000-0000"
• Phone No (After Hours): e.g”06-000-0000"
• Cellphone No: e.g”027-000-0000” *
• Date of birth of the student (Use DD/MM/YYYY) / DD / MM YYYY
• Ethnicity *
  NZ European Maori Samoan Tongan Chinese Korean Other
• If other, please specify
• Parent / Caregiver's name * First Last
• Name of school which student will attend in 2021: *
• Please select if you would like to express your interest in serving as a Trustee or Parent representative on the Saturday Music Board. (Refer to the handbook for further information) * Yes No
• How did you come to know about the Saturday Music Program?
  Previously attended School notice Friends informed me Newsletter Library display
• Preferred class times (First Choice): Please select one * 8.30 9.00 9.30 10.15 10.45 11.15 Any time
• Preferred class times (Second Choice): Please select one * 8.30 9.00 9.30 10.15 10.45 11.15 Any time
• If you are enrolling more than one child, would you prefer the classes to be
  at the same time one after the other either completely different times
• Are there any times your child cannot attend? 8.30 9.00 9.30 10.15 10.45 11.15
• Does the student have any brothers/sisters who are also being enrolled for a Saturday Music (PN) class? * Yes No
• Name of brother/sister
• Instrument/class
• Name of brother/sister
• Instrument/class
• Please list any medical issues or other information which Saturday Music (PN) should know about. Note that all information that will affect the student's ability to participate fully in a class, and within a group setting, must be disclosed (please see the Saturday Music (PN) policy at the bottom of page 3 in the handbook). Otherwise state 'Nil' *
• List any other information about the student which we should know that will enable us to give him/her the best possible tuition. Otherwise state 'Nil'
• Has the student previously attended any Music Basics classes? * Yes No
• If so, which year did he/she attend?
  Year 1 Year 2 Year 3
• Has the student learned an instrument before? * Yes No
• If so, which instrument, and for how many years?
• List any other musical experience the student has. *
• How well is the student able to read Music? *
  Very well Moderately well Only a little Not at all
• Can the student read any of the following? Treble Clef Bass Clef TAB Guitar chords Drum notation
• If the student is enrolling in a drum class, is he/she right handed or left handed? LH RH
• Students enrolling in a drum class must be at least 125 cm tall. Does your child meet this height requirement? Yes No Not applicable