Special Music Program

Student Name* This field is required.

First Name

Last Name

Date of Birth* This field is required.

Date

Student Gender* This field is required.

Parent Title* This field is required.

Mrs

Miss

Parent Name* This field is required.

First Name

Last Name

Parent Email Address* This field is required.

example@example.com

Home Address* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Mobile Number* This field is required.

Current Student Primary School* This field is required.

Does the student have any important medical conditions that we need to know about?* This field is required.Particularly conditions that could affect them during the trials. Please list them below.

Does the student have any siblings attending, or who have attended Safety Bay Senior High School? If yes, please provide their name* This field is required.

Please provide a copy of the student's most recent School Report* This field is required.If you are unable to upload a recent school report, please contact Administration on 9528 9200.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

Do you give permission for the student to be photographed and recorded during the trials?* This field is required.Photographs and videos may be used for promotional purposes.

YESNO

Is the student currently part of the Department of Education Instrumental Music School Services (IMSS) program?* This field is required.

YESNO

Tell us a bit about the student's interest and experience with music.* This field is required.e.g. Instruments learnt, number of years, performances, choir, band experience...

Can the student read music?* This field is required.

YESNO

Where does the student have music lessons?* This field is required.

School Music Lessons

Private Music Lessons

Both

None

Other

What instrument does the student play?* This field is required.

How long has the student been playing the instrument?* This field is required.

How did you hear about the Special Music Program?* This field is required.Select all that apply

Facebook

School Sign

Connect

Local Newspaper

Primary School notice/newsletter

Poster

Promotional brochure

Safety Bay SHS Website

Other