Change Of Consent Form

CHANGE OF CONSENT FORM

STUDENT DETAILS

STUDENT INVOICE NUMBER*

Full Name*

First NameLast Name

Student Date Of Birth*

Date

PARENT OR LEGAL GUARDIAN DETAILS

Full Name*

First NameLast Name

Address*

Address Line 1

Address Line 2

CityCounty

Post Code

Phone Number*

Email*

example@example.com

STUDENT AGE VERIFICATION

(The legal definition of a child in England, Wales and Northern Ireland is someone who has not yet reached their 18th birthday. On reaching 18 a person legally becomes an adult. Treating a person who is under 18 years as a child, is in keeping with Article 1 of the United Nations Convention of the Rights of the Child)

Please Verify Student Age*

The student is 18 years of age or above 18 years of ageThe student is below 18 years of age

PARENT OR LEGAL GUARDIAN CONSENT

(Please only complete this section if the student is below 18 years of age and will be attending our Harrow studios for lessons.)

Part 1*

I would like my child to make their own way unaccompanied to the music lesson and enter The Artistic School of Music Premises alone. I understand and accept this would be solely my responsibility and liability.I will accompany my child and enter The Artistic School of Music Premises and hand over my child to the teacher for the music lesson.

Part 2*

I give my consent and want my child to be allowed to leave the music lesson once it has ended and make their own way back to me alone. I understand and accept this would be solely my responsibility and liability.I want my child to be kept in the music lesson once it has ended and until I collect them from the teacher.

Todays Date (Automated)

Date

Parent or Legal Guardian Signature*