Student Enrolment Form

Name*

First NameMiddle NameLast Name
Gender*
Birth Date*

DayMonthYear
Home Address*

Street Address

Street Address Line 2

Town/CityState

Post Code
Mobile Number*
E-mail*
example@example.com
Place of Employment
Second Alternate Emergency Contact

The following person can be contacted in an emergency.
Emergency Contact*

PrefixFirst NameLast Name
Relationship to Student*
Mobile Number*
Information
Is the Student:*

A relation of an existing student?Aboriginal or Torres Strait Islander descent?Have a language background other than English?None of the above.
Are you aware of any medical conditions, diagnosis or disabilities?:*

YesNo
If you aware of any medical conditions, diagnosis or disabilities - please give details
Do you have an emergency medical plan? Please attach a copy

Cancelof
Program Details

Please provide details of the lesson, group or ensemble you are interested in
INSTRUMENT / GROUP / ENSEMBLE TO BE ENROLLED:*
LOCATION OF LESSON*

HRC Muswellbrook CampusSchool Based LessonsHRC Singleton Campus
Teacher Preference
Time Restrictions or helpful availability information
Lesson length details:*

Individual 20 minute lessonIndividual 30 minute lessonIndividual 45 minute lessonIndividual 60 minute lessonAdvanced Voice 30 minutesAdvanced Voice 60 minutesHarp 30 minutesHarp 60 minutesShared 30 min Lesson (subject to availability) - please contact usDramaEnsemble
INSTRUMENT ARRANGEMENTS*

Hire from HRC (Strings, Woodwind, Brass & Guitar Only)I have my own instrumentN/AOther
DECLARATION

By signing below, I accept full responsibility for the payments of all accounts pertaining to this enrolment as detailed on this enrolment form. I understand that non-payment of fees may result in referral to a recovery agent, and will incur collection fees.
Signature*

Clear
Date*

MonthDayYear
Date
AUTHORITY TO USE PHOTOGRAPHIC or VIDEO/FILM IMAGES

AUTHORITY TO USE PHOTOGRAPHIC or VIDEO/FILM IMAGES
Signature*

Clear
Permission for photographic content -
Date*

DayMonthYear
Date
You're Almost There!!!

Just one last question to help out our Admin
How did you hear about the HRC?*

Referred by a friendRadio/Newspaperprevious enrolmentSchool recommendationSocial MediaGoogle/search engineOther
Sign me up to receive emails about concerts, workshops and new programs!

Sign me up please.
Should be Empty:

Second Alternate Emergency Contact

Information

Program Details

DECLARATION

AUTHORITY TO USE PHOTOGRAPHIC or VIDEO/FILM IMAGES

You're Almost There!!!