Student nomination form

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To be completed by parent/guardian. Please use a parent/guardian email address below.
Applications close: Friday 15 July 2022.
Minimum deposit of $250 due with application form.
Final payments due Friday 31 August 2022.

Total cost
Public school students - $500
Non DoE students - $550

Email *

Student first name: *

Student surname *

Gender *

Student address: *

School: *

Year: *

Student mobile: (please input as XXXX XXX XXX)

(if applicable)

To assist with funding and statistical analysis of our programs can you please note if any of the following apply to you:

Aboriginal or Torres Strait Islander

English as an additional dialect

Student with a disability

Student from a school in rural NSW

T-shirt size: (this will be your camp t-shirt size) *

Ensemble nomination

List your instruments in order of preference for camp, including voice. Experience includes level of exams, workshops, lessons, bands you rehearse/perform with, choirs, vocal ensembles, eisteddfods, larger performances such as Southern Stars/Schools Spectacular etc.
Also include your level of involvement e.g. soloist, featured artist etc. Ensure you put the type of instrument in its entirety e.g. Bb clarinet, electric guitar, alto sax.

First instrument *

Experience *

Second instrument

Experience

School contact teacher name *

School contact teacher email

School principal name *

Payment information

All payments are made through Pleasant Heights Public School
1. Go to the Pleasant Heights PS website at www.pleasantht-p.schools.nsw.edu.au
2. Click on “Make A Payment”
3. Complete this page by entering Given Name, Surname, DOB
4. Complete “Payer Details”
5. Click “Other” and complete “Payment Description 1” as follows:
a. SCMC – John Smith (Student’s full name)
b. Minimum deposit payment amount ($250)
6. Complete credit card details and print receipt (you will need to put receipt number below)

Deposit payment receipt number: *

Parent/guardian information

Parent/guardian name: *

Parent/guardian email: *

Parent/guardian mobile: (please input as XXXX XXX XXX) *

Parent/guardian consent

Please confirm each of the following: *

I give permission for my child/ward to participate in the 2022 South Coast Music Camp

I acknowledge that this event is required to be held in accordance with any current NSW Health COVID-19 Public Health Orders and the NSW Department of Education’s policies and procedures. I acknowledge and accept that there is a risk that my child may be exposed to COVID-19 whilst attending and participating at this event. I confirm that my child will not attend if displaying any symptoms of illness, and/or if directed to isolate under public health orders.

Required

Permission to publish

The South Coast Music Camp committee are seeking your permission to obtain and publish content that may include the image and/or name of your child in our publicly of the camp.
Content examples include but are not limited to photographs, text, illustrations/graphics, videos, sound recordings, examples of student work.
Our school communications include but are not limited to:
• Department of Education websites, including school public websites.
• School newsletters (online and hard copy)
• Local community newspapers
• SCMC Facebook page
• SCMC promotional video
• Media promotions and advertising activities
• Electronic and print promotional material

Please select appropriate response: *

My child/ward has permission to be published as part of the SCMC.

My child/ward DOES NOT have permission to be published as part of the SCMC.

A copy of your responses will be emailed to the address you provided.

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