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HUNTER REGIONAL CONSERVATORIUM
STUDENT ENROLMENT FORM
32
Questions
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1
Student Name
*
This field is required.
First Name
Middle Name
Last Name
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2
Student Gender
*
This field is required.
Please Select
Male
Female
N/A
Please Select
Please Select
Male
Female
N/A
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3
Birth Date
*
This field is required.
-
Day
Month
Year
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4
Student Age
*
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5
School Student Currently Attends:
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6
Year Level at school
*
This field is required.
Please Select
Adult
Early Childhood
Pre-School
Kindergarten
Year 1
Year 2
Year 3
Year 4
Year 5
Year 6
Year 7
Year 8
Year 9
Year 10
Year 11
Year 12
Please Select
Please Select
Adult
Early Childhood
Pre-School
Kindergarten
Year 1
Year 2
Year 3
Year 4
Year 5
Year 6
Year 7
Year 8
Year 9
Year 10
Year 11
Year 12
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7
Parent / Carer Name
*
This field is required.
Prefix
First Name
Last Name
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8
Home Address
*
This field is required.
Street Address
Street Address Line 2
Town/City
State
Post Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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9
Mobile Number
*
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10
E-mail
*
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example@example.com
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11
Place of Employment
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12
Emergency Contact
*
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Prefix
First Name
Last Name
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13
Relationship to Student
*
This field is required.
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14
Mobile Number
*
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15
Is the Student:
*
This field is required.
The sibling of an existing student?
Aboriginal or Torres Strait Islander descent?
Identified as Gifted and Talented by their School?
Have a language background other than English?
None of the above.
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16
Are you aware of any medical conditions, diagnosis or disabilities?:
*
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Yes
No
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17
If you aware of any medical conditions, diagnosis or disabilities - please give details
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
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18
Does your child have an emergency medical plan? Please attach a copy
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
Browse Files
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19
INSTRUMENT/GROUP/ENSEMBLE TO BE ENROLLED:
*
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20
LOCATION OF LESSON
*
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Please note that multiple location choices could lead to faster placement for lessons-
UHCM Muswellbrook Campus
School Based Lessons
UHCM Singleton Campus
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21
Teacher Preference
(if known)
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22
Time Restrictions or helpful availability information
to assist with scheduling
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23
Image Field
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24
Lesson length details:
*
This field is required.
Please select an option below:
Individual 20 minute lesson
Individual 30 minute lesson
Individual 45 minute lesson
Individual 60 minute lesson
Advanced Voice 30 minutes
Advanced Voice 60 minutes
Harp 30 minutes
Harp 60 minutes
Shared 30 min Lesson (subject to availability) - please contact us
Drama
Other
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25
INSTRUMENT ARRANGEMENTS
*
This field is required.
Hire from HRC (Strings, Woodwind, Brass & Guitar Only)
I have my own instrument
N/A
Other
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26
Terms and Conditions of Enrolment
*
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27
Parent/Carer Signature (OR Student Signature if over 18)
*
This field is required.
Clear
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28
Date
*
This field is required.
-
Date
Month
Day
Year
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29
Parent/ Guardian Signature
*
This field is required.
I give permission for the student detailed in this enrolment, as a student of the Hunter Regional Conservatorium, permission to have his/her image used in official publications, video recordings or for promotional purposes by the Hunter Regional Conservatorium and/or the New South Wales Department of Education. I also give my permission for the student enrolled to be interviewed for promotional purposes.
Clear
Permission for photographic content -
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30
Date
*
This field is required.
.
Date
Day
Month
Year
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31
How did you hear about the HRC?
*
This field is required.
Referred by a friend
Radio/Newspaper
previous enrolment
School recommendation
Social Media
Google/search engine
Other
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32
Sign me up to receive emails about concerts, workshops and new programs!
We don't send many we promise...
Sign me up please.
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