Home Music Tuition Online Application Form Please complete this form to apply for tuition. Your details will then be passed to a Musica Kirklees teacher to arrange your lessons. Information about lessons and prices > Please select pupil age group? Pupil Age Group (application) * Children School Year 13 or below Adults / Students above School year 13 Choose Instrument Woodwind Flute Oboe Clarinet Recorder Saxophone Bassoon Brass French Horn Trumpet Cornet Trombone Tenor Horn Baritone Horn Euphonium Tuba Strings Violin Viola Cello Double Bass Guitar Ukulele Acoustic Guitar Classical Guitar Electric Guitar Bass Guitar Percussion Drum Kit Percussion Keyboard Keyboard Piano Voice Singing Do you wish to loan an instrument? * This is to help us monitor our instrument stock. When lessons start, you will be advised by the teacher to contact the Musica Kirklees office to make the loan arrangements. For pupils with SEND where standard instruments may not meet their needs, Adaptive Instruments can be offered. Please email [email protected] with details of your needs or for more information. Yes No Instrument Ability (approx.) * -- Select -- Beginner Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Grade 7 Grade 8 Grade 8+ Pupil Details First Name * Last Name * Date of Birth * Gender * -- Select -- Male Female Other Prefer not to say Gender Other (please specify) * Ethnicity * -- Select -- WBRI - White British WIRI - White Irish WIRT - Traveller of Irish Heritage WROM - Gypsy/Roma WOTH - Any Other White Background BAFR - Black African BCRB - Black Caribbean BOTH - Any Other Black Background ABAN - Bangladeshi CHNE - Chinese AIND - Indian APKN - Pakistani AOTH - Any Other Asian Background MABL - Asian and Black MWBA - White and Black African MWBC - White and Black Caribbean WCHIN - White and Chinese MWAS - White and Asian MOTH - Any Other Mixed Background OOTH - Any Other Ethnic Group NOBT - Info Not Obtained REFU - Refused Phone Number * Email * Current School (year 13 or below) * -- Select -- Other (School not listed) All Hallows' CE (VA) Primary School All Saints Catholic College, Specialist in Humanities Ashbrow School Batley Girls' High School Batley Grammar School Batley Parish CE (VA) J I and N School Battyeford CE (VC) Primary School BBG Academy Beaumont Primary Academy Belmont Grange Ukuleles Berry Brow I and N School Birdsedge First School Birkby I and N School Birkby Junior School Birkenshaw CE (C) Primary School Birstall Primary Academy Boothroyd Primary Academy Brambles Primary Academy Brockholes CE (VC) J and I School Bywell CE (C) Junior School Carlinghow Academy Carlton J and I School Castle Hall Academy Trust Castle Hill School Christ Church CE Academy Clough Head J and I School Colne Valley High School Co-op Academy Smithies Moor Crossley Fields J and I School Crow Lane Primary and Foundation Stage School Crowlees CE (VC) J and I School Cumberworth CE (VA) First School Dale House School Dalton School Junior Infant and Nursery Denby CE (VA) First School Denby Dale First and Nursery School Diamond Wood Community Academy Earlsheaton Infant School East Bierley CE (VC) Primary School Eastborough J I and N School Emley First School Engage Academy (EAT) Ethos College (EAT) Fairfield School Farnley Tyas CE (VC) First School Field Lane J I and N School Fieldhead Primary Academy Fixby J and I School Flatts Nursery School Flockton CE (C) First School Friends of Beaumont Park Ltd Golcar J I and N School Gomersal Primary School Gomersal St Mary's CE (VC) Primary School Grange Moor Primary School Greenhead College Hade Edge J and I School Hanging Heaton CE (VC) J and I School Hartshead J and I School Headfield CE (VC) Junior School Headlands CE (VC) J I and N School Healey J I and N School Heaton Avenue Primary School - Academy Heckmondwike Primary School Helme Church of England Academy Hepworth J and I School High Bank J I & N School Highburton CE First Academy Hightown Junior Infant & Nursery School Hill View Academy Hillside Primary School Hinchliffe Mill J and I School Hollybank School Holme J and I School Holmfirth High School Holmfirth J I and N School Holy Spirit Catholic Primary School Honley CE (VC) J I and N School (Infant & Nursery Site) Honley CE (VC) J I and N School (Junior Site) Honley High School Hopton Primary School Howard Park Community School Huddersfield New College Hyrstmount Junior School Joseph Norton Academy Kaye's Academy King James's School Kirkburton CE (VA) First School Kirkburton Middle School Kirkheaton Primary School Lepton CofE Primary Academy Lily Park Primary School Lindley Church of England Infant School Lindley Junior School Linthwaite Ardron CE (VA) J and I School Linthwaite Clough J I & Early Years Unit Littletown J I and N School Lowerhouses CE (VC) J I and EY School Luck Lane Primary Lydgate J and I School Manor Croft Academy Manorfield I and N School Marsden I and N School Marsden Junior School Meltham CE (VC) Primary School Meltham Moor Primary School Mill Lane Primary School Millbridge J I and N School - sponsored Academy with Shelley College Moldgreen Community Primary School Moor End Academy Moorlands Primary School Mount Pleasant Primary School Netherhall Learning Campus High School Netherhall Learning Campus Junior School Netherthong Primary School Netherton I and N School New Mill Infant School New Mill Junior School Newsome High School and Sports College Newsome Junior School Nields J I and N School Norristhorpe J and I School North Huddersfield Trust School Oak CE (VC) Primary School (Infant) Oak CE (VC) Primary School (Junior) Oak CE (VC) Primary School (Nursery) Old Bank School Primary Academy Orchard Primary Academy Our Lady Of Lourdes Catholic Primary School Overthorpe C of E Academy Paddock J I and N School Park Road J I and N School Pentland I and N School Purlwell I and N School Ravenshall School Ravensthorpe CE (VC) Junior School Netherhall St James CE (VC) I & N Reach Academy (EAT) Reinwood Community Junior School Reinwood I and N School Roberttown CE (VC) J and I School Rowley Lane J I and N School Royds Hall Secondary Salendine Nook High School Academy Savile Town CE (VC) I and N School Scapegoat Hill J and I School Scholes (Holmfirth) J & I School Scholes Village Primary School Scissett CE Academy Scissett Middle School Shaw Cross I and N School Shelley College Shelley First School Shepley First School Skelmanthorpe Academy Slaithwaite CE (VC) J & I School South Crosland CE (VA) Junior School Southgate School Spen Valley High School Spring Grove J I & N School St Aidan's C of E Academy St John Fisher Catholic Voluntary Academy St John's CE (VA) J and I School (Golcar) St John's CE (C) Primary School (Dewsbury) St Joseph's Catholic Primary Academy (Huddersfield) St Joseph's Catholic Primary School (Dewsbury) St Mary's Catholic Primary School, Batley St Patrick's Catholic Primary School (Birstall) St Patrick's Catholic Primary School (Huddersfield) St Paulinus Catholic Primary School St Peter's CE (VA) Junior, Infant and Early Years School St Thomas CE (VC) Primary School Staincliffe CE (VC) Junior School The Mirfield Free Grammar Thornhill Community Academy Thornhill J and I School Thornhill Lees CE (VC) I and N School Thurstonland First School Upper Batley High School Upperthong J and I School Warwick Road Primary School Wellhouse J and I School Westborough High School Westmoor Primary School Whitcliffe Mount School Whitechapel Church of England Primary School Wilberlee J and I School Windmill Church of England Primary School Woodley School and College Woodside Green Primary School School Other (please specify) * Home Address Line 1 * Address Line 2 Town * Postcode * Special Education Needs and/or Disability (SEND) * Yes No Special Education Needs and/or Disability (SEND) Medical condition(s) Musica Kirklees to be aware of * Yes No Medical condition(s) Musica Kirklees to be aware of Preferred location for lessons * Batley Holme Valley Mirfield Colne Valley Huddersfield Shelley If a pupil cannot be accommodated in their school, we will endeavour to accommodate them at one of our central class venues at one of our music centres. Please select from the centres below: * -- Select -- Batley Holme Valley Mirfield Colne Valley Huddersfield Shelley Parent / Carer Details Title * First Name * Last Name * Home Tel. * Mobile * Email * Please select your preferred lesson type Please note:Prices are valid for the current year and are subject to annual review Group lessons are with no more than 3 pupils and are a more affordable option to having an individual lesson. * If a group is not available, pupils can receive shorter individual lessons You can request any option but more advanced students (grade 6+) may find Option C or D lessons most beneficial. Option A *group of 2 pupils for 20 mins or group of 3 pupils for 30 mins Option B *group of 2 pupils for 30 mins or an individual lesson of 15 mins Option Cindividual lesson for 20 mins Option Dindividual lesson for 30 mins Your Lesson Price * Option A or B Explanation * Where lesson sharing is not a viable possibility, Option A pupils will receive 10 minute individual lessons and Option B pupils will receive 15 minute individual lessons. Payment Information Invoices will be sent by email to the address provided in this form. Would you like to receive SMS notifications when e-invoices have been sent to you? * Yes No Would you like to pay by Direct Debit? * Yes - please send me a form / add this activity to my existing Musica Kirklees Direct Debit* No - I do not wish to pay by Direct Debit / I do not want to add this activity to my existing Musica Kirklees Direct Debit *Please note: if your household already has a Direct Debit in place, we can only add new activities to that Direct Debit if the name of the person completing the declaration at the bottom of this form matches the named payer on the existing Musica Kirklees record. Otherwise, a new mandate will be sent for you to complete for this activity. Newsletter Preferences Would you like to subscribe to the Musica Kirklees termly email newsletter? * The termly newsletter contains lots of important information about opportunities, events and dates for your diary across the whole of Kirklees and it's recommended that you subscribe. You can unsubscribe at any time. Yes No How You Discovered Musica Kirklees How did you first find out about Musica Kirklees and the learning opportunities that we offer? * -- Select -- Word of mouth / personal recommendation The pupil or a family member have Musica Kirklees lessons or attend groups already 'Give it a Go' taster sessions Whole class tuition in school (any instrument) Online search / website / social media Assembly, recital or workshop at school Attended a public performance or event Leaflet, flyer or poster Other Any Other Information Any other information you wish Musica Kirklees to be aware of regarding this application Declaration Lesson Declaration * I have read and agree to abide by the full Terms and Conditions (if you are unable to view pop-ups, please use this link to read the Terms and Conditions) I understand that lessons will continue term on term and year on year. I agree to advise Musica Kirklees office in writing by the date specified within the Terms and Conditions (if you are unable to view pop-ups, please use this link to read the Terms and Conditions) should I wish for lessons to discontinue at the end of a term. Signed by * Signed By (First name) * Signed By (Last name) * Confirm Application
