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Thursday 17th June4pm-6pm
The form to take part in the masterclass is here:
Please print it off and send it in well in advance to take part.
For a PDF version click here.
Application form for Piano (Grade 2+) Masterclass with Marcel Zidani,
Thurs 17 June 2010, 4-6pm, St Michael's Church, Church St., Broadway
Student Name:_____________________________________________
Home Address:__________________________________________________
Postal Town:_________________________Postcode____________________
Parent/ Carer's Full Name_________________________________
Phone (day):______________ (evening):________________ Email:________________
Name of school:_________________________________Year group__ Age____
All: Years I have studied piano:_______________Grade(s)______
Name of regular teacher:_________________ Phone number:_____________________
Other instruments studied and standard achieved:_______________________________
________________________________________________________________
I would like to take part in this course because_________________________________
Pieces(s) I would like to play (composer, title)_______________________________
________________________________________________________________
Disabilities/special needs:_____________________________________________
Allergies__________________________Medicines ___________________
CONSENT
I agree to allow my child to take part and understand that all under 16's must be accompanied.
Photo/video of my child may be used for promotional purposes (print and online)__ (Tick if you agree)
________________________ _______
Parent/Carer signature Date
Please enclose a cheque for £5 payable to Broadway Arts Festival and return this form to M. Schmitz, 1 Leamington Road, Broadway, WR12 7EF
