Purbeck Instrument Loan Application

Purbeck Instrument Loans

Application Form
Instruments available to request: violin, viola, cello, double bass, flute, oboe, clarinet, saxophone, bassoon, trumpet, horn, trombone, euphonium, tuba.

Please complete a separate form for each child

You will be directed to payment at a later date, once your application has been approved.
Instrument*
Pupil's Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Name of School*
School Year*
Just a number
Parent's Name*

First NameLast Name
Address*
Phone*
Email*
example@example.com
Name of teacher providing lessons*
Contact details of teacher if learning outside school
If outside school, these details are a requirement for the loan.
Terms & Conditions*

I have read and accept the terms and conditions for instrument hire. I understand that copies of this are available on the Purbeck Youth Music website.
Data Protection*

I give consent for my details (as provided on my Purbeck Instrument Loan Scheme application form or subsequent update forms) to be held digitally for the purposes of administering the Loan Scheme. I understand that my details will not be passed to any 3rd party and they will be deleted when I leave the Scheme.
Photography*

I give consent for photographs to be taken of my child/ children performing, competing, or taking part in lessons & workshops. I understand they will not be named and only photographs may be published, not videos.I do not give consent
Autoresponder Email
example@example.com
PYM Sender
Should be Empty:

Purbeck Instrument Loans