Instrument Choice

Please select which instrument you would like to receive free tuition in.  Using the numbers 1 - 5, with 1 being your favourite and 5 being your least favourite choice, mark a number in the box next to the instrument. We will try to allocate your first choice, however this may not always be possible.

Guitar       
Bass Guitar 
Keyboard   
Drum Kit    
Voice         

Media

As this is a national initiative there may be videos, photos and radio broadcasts carried out throughout the project, which can be used by Falkirk Community Trust, Falkirk Council and Creative Scotland. 

Do you give permission for your child to be involved in this section? Yes No

Pupil Information

Name:  
School:  
Age:   Class:

Contact Information

Parents Name:  Tel Number:
Address:         
Post Code:      
Mobile Tel:     
Email:            

Emergency Contact

Name:  Tel Number:

Medical Information

Does your child suffer from any medical conditions or allergies that we need to be aware of, if so what is it? (If yes please state.)

Is your child on any medication that we need to be aware of, if yes what is it? (If yes please state.)