Hereford Music Shop

1. Student Name

2. Instrument

3. Teacher

Pete Wilkinson

Joe Standell

Marcus Burton

Simon Clarke

Jane Bovell

Chris Butts

Orin Vallely

Stephen Gowland

Henry Barnett

Andi Licqurish

Luke Strong

Hayley Osborne

4. Is Student over 18?

Yes

No

5. If no then is the student allowed to leave the premises alone?

Yes

No

6. Student’s Telephone Number

7. Student’s Email Address

8. If Student is under 18 then Parent or Guardian's Name

9.Parent or Guardian's Telephone Number

10.Parent or Guardian's Email Address

11. Anything extra you’d like us to know?

This form is for existing students not for lesson enquiries

I understand