Instrument Loan: Payment Gateway

Date of Payment*

Date

Please enter your details and select item(s) for payment. You must apply for and be granted an instrument by PYM BEFORE completing this form.

Instrument Loans

Annual contribution 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.

Parent / Guardian*

First Name (or Mr/Mrs)Last Name

Email*

you@example.com

Phone*

Just in case

Student Name*

First NameLast Name

School Year*

School*

Instrumental Tutor Name*

Details

Please add a short note here to explain what your payment is for. Also any extra information here - e.g. if you are paying for more than one instrument, or for more than one individual.

Sender

Sender Email

example@example.com

Please click below those that apply.

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 administration. I understand that my details will not be passed to any 3rd party and they will be deleted when no longer required. 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

Please Select

Please read the options carefully and then select item and quantity for payment.

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

Total £0.00

Payment

Please click below to check your order and make a secure payment.

PYM Payment Gateway