Orange Regional Conservatorium | Lesson and Groups Enrolment Form Student Information Name * First Name Last Name Date of Birth * Gender * Female Male Other Student Type * Early Childhood (pre school aged) School Aged Adult School Attending in 2024 Year Level in 2024 Does the student suffer from a medical condition, allergy or a disability? * Yes No If yes, please provide details Account and Contact Details If student is under 18 years – please provide name and contact details of Parent and/or Guardian Name First Name Last Name Relationship to Student * Phone Number * primary Phone Number Secondary Email * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Emergency Contact Information * name, relationship to student, phone Billing email address if different from above I would like to receive regular email newsletters and updates Tuition Details Instrument / Ensemble / Subject * Lesson Length (N/A for ensembles) * For individual lessons 20 Minute 30 Minute 45 Minute 60 Minute Unsure Preferred Day of Week/Time Preferred Teacher If unknown or undecided please leave blank Demographic Details As part of our requirements with the NSW Department of Education & Communities (DEC), we are required to provide the following information about our students. Is the student of Aboriginal or Torres Strait Islander descent? * Yes No Does the student speak a language other than English at home? * Yes No If yes, what language is also spoken? Photography / Video Permission The Orange Regional Conservatorium and / or the NSW Department of Education & Communities may use photographic or video images of my child or myself for promotional or educational purposes. Do you provide permission for you and/or your child to be photographed or videoed for these purposes? * Yes No I have read and understand the Terms & Conditions of enrolment * Yes Thank you! A teacher will be in contact with you as soon as possible. PLEASE CLICK HERE TO READ OUR ENROLMENT TERMS & CONDITIONS
