RocksCool Registration Form
Name:
D.O.B.:
Address:
Sex: Female Male
Email address:
Do you play an instrument already?:
Why do you want to be part of RocksCool?:
Do you have any medical conditions?:
Do you have a disability?:
Can you provide an emergency contact & telephone number.:
I agree that all information held will be used for monitoring & evaluation: I agree I disagree
Please tick which RocksCools you are interested in.: Adult RocksCool Ashington Bedlington Berwick Birmingham Blyth Cramlington Durham Edinburgh Gateshead Gosforth Heaton Hexham Leeds Liverpool London Manchester Middlesborough Morpeth Newcastle North Shields Seaton Delaval SUMMER CAMP Sunderland West Denton Whickham York
I agree that any photgraphs taken can be used for publicity for RocksCool Academy: I agree I disagree
Which School Do You Attend:
What is the name of your nearest musical instrument shop?:
Please type the text below:
