Instrument Loan: Payment Gateway

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Beginner Groups or Taster SessionsInstrument Loan RenewalsEnsemble Rehearsals
We're currently running beginner groups and taster sessions for Brass and Violins. Please indicate which group:

Brass (trumpet, horn, trombone, euphonium etc)Violin
Instrument Loans

Renewal per student per year is £23.

Family membership is £23 per year for one child and £3 each for additional siblings.

There is no charge for a 2nd or 3rd instrument.
Payment is for how many instruments?
Instrument 1
Type of Instrument loaned and instrument loan number
Instrument No 2
Type of Instrument loaned and instrument loan number
Instrument No 3
Type of Instrument loaned and instrument loan number
Instrument No 4
Type of Instrument loaned and instrument loan number
Your details
Parent / Guardian*

First Name (or Mr/Mrs)Last Name
Email*
you@example.com
Phone*
Just in case
Payment is for how many individuals / players?*
Student Name*

First NameLast Name
School Year*
Tutor*
School*
Student 2 Name

First NameLast Name
School Year (2)
Tutor (2)
School (2)
Student 3 Name

First NameLast Name
School Year (3)
Tutor (3)
School (3)
Student 4 Name

First NameLast Name
School Year (4)
Tutor (4)
School (4)
Sender
Sender Email
example@example.com
Extra Details

Please add any extra information here - e.g. if you are paying for a combination of different items - just add a short note here to explain.
Loan Terms and Conditions

I have read and accept the terms and conditions for instrument loan. 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 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. I understand that a copy of the PYM Privacy Statement is available on the PYM website.
Photography

I give consent for photographs or video to be taken of my child/children performing, competing, or taking part in lessons & workshops. I understand they will not be named.I do not give consent
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Beginner Group / Taster Sessions @ £2.50
Please contribute here for the full series of introductory Beginner Groups or Taster Sessions for your instrument. PYM will have confirmed how many sessions there are in the series - please select this number below.

No. of sessions

Ensemble Rehearsals @£2.50
Ensembles are the groups set up by tutors for playing and performing together. These include Brass and Woodwind ensemble, and the Folk Violin Ensemble. Tutors will confirm the number of Ensemble Rehearsals each term; please select that number below.

No. of rehearsals

Instrument Loans: 1 year£23.00
Annual Junior PYM membership and subscription for loan of an instrument for one school year. Memberships renew every September. Select ONLY if you have had your instrument loan approved and confirmed.

Quantity

Additional Instrument Loans - for siblings£3.00
Annual Junior PYM Membership fee £3 - entitles a sibling to one instrument loan for a school year. Select ONLY if you have had your instrument loan approved and confirmed.

Quantity

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