1.Participant Details

Student Name

Parent Guardian Name

Best Contact Email Address

Best Contact Phone Number

Participant Age

School

Music Teacher

2.Emergency Contact Information - additional to above contact

Name

Phone number 

Relationship to participant 

3.I, the parent/guardian of the above student, give permission for him/her to be photographed or filmed during the workshop at the Empire Theatre. 

Yes 

No 

4.What is your current AMEB level?

5.Do you have a piece of music you are currently working on? Please specify