Arts Alive Combined Schools Bands 2022 -Returning students nomination form

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Ensemble rehearsal details for 2022:

PRIMARY CONCERT BAND (Years 4 to 6)
Monday 5:00 pm - 6:30 pm @ Belrose Public School

JAZZ ENSEMBLE (Years 6 to 9)
Monday 6:30 pm - 7:45 pm @ Belrose Public School

SECONDARY CONCERT BAND (Years 7 to 12)
Wednesday 6:00 pm - 7:30 pm @ Belrose Public School

Please note, in addition to this form, both the PARENT PERMISSION FORM (bit.ly/PPFaacsb22) and SCHOOL ENDORSEMENT FORM (bit.ly/SEFaacsb22) must be completed and submitted to the email address indicated on the forms.

Membership fees for the 2022 Arts Alive Combined Schools Bands are $420 for the year (per ensemble). No payment should be made at this stage - payment information will be distributed in early 2022.

For further information, please contact artsaliveCSB@hotmail.com.

Email *

Student First Name *

Student Surname *

Student Gender *

Female

Male

Prefer not to say

Other:

School (2022) *

Student School Year 2022 *

Year 4

Year 5

Year 6

Year 7

Year 8

Year 9

Year 10

Year 11

Year 12

Ensemble Selection for 2022 *

Primary Concert Band (Years 4-6) - Monday 5:00pm-6:30pm

Jazz Ensemble (Years 6-9) - Monday 6:30pm-7:45pm

Secondary Concert Band (Years 7-12) - Wednesday 6:00pm-7:30pm

Required

Student Instrument #1 *

Experience on Instrument #1 *

Please include any formal examinations you have completed (eg. AMEB / Trinity / etc).

Student Instrument #2

(optional)

Experience on Instrument #2

(optional) Please include any formal examinations you have completed (eg. AMEB / Trinity / etc).

Student Home Address *

Student Home Suburb *

Student Home Postcode *

Student Home Phone

(if applicable)

Student Mobile Phone

(if applicable)

Student Contact Email Address *

Name of School Contact Teacher

Name of School Principal

Parent First Name *

Parent Surname *

Parent Mobile Phone *

Parent Email Address *

Parent Relationship to Student *

Mother

Father

Grandparent

LegalGuardian

Other:

Additional Parent First Name

(optional)

Additional Parent Surname

(optional)

Additional Parent Mobile Phone

(optional)

Additional Parent Email Address

(optional)

Additional Parent Relationship to Student *

(optional

Mother

Father

Grandparent

Legal Guardian

Other:

Student Medicare Card Number *

Please include position on card

Private Medical Insurance Information

(if applicable)

My child has the following special needs or medical conditions: *

If none, please write N/A

My child has the following allergies: *

If none, please write N/A

My child has an Anaphylaxis and/or Asthma Action Plan *

If your answer to this question is yes, a copy of the action plan MUST be directly emailed to the ensemble coordinator (artsaliveCSB@hotmail.com) on submission of this application.

YES, Anaphylaxis only

YES, Asthma only

YES, both Anaphylaxis and Asthma

My child currently takes the following medication (please provide as much detail as possible): *

If none, please write N/A

Emergency Contact Information

Please provide information of TWO emergency contacts who are not listed in parent section of this application. Please indicate their name, contact details and relationship to the child.

Application Agreement *

Please ensure all boxes are ticked prior to submitting.

I understand that, in addition to submitting this online form, I need to complete and submit the PARENT PERMISSION FORM and SCHOOL ENDORSEMENT FORM.

I understand that a fee is payable to be a member of the Arts Alive Combined Schools Band program.

I understand that, to be a member of the Arts Alive Combined School Bands, the student must attend all scheduled rehearsals and performances, and must abide by the NSW Department of Education's behaviour code.

Required

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

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