PopRoX Enrolment Form

Enrolment and Consent Form

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Student Details

Student First Name *

Student Last Name *

Student Age

Student Date of Birth

Parent/Guardian Details

This form is to be completed by the Parent or legal Guardian of the above named student. Please ensure all fields are completed. Also ensure you provide an emergency contact number and at least one other additional emergency contact.

Parent/Guardian Name *

Parent/Guardian Address *

Parent/Guardian Home Phone *

Parent/Guardian Mobile Phone *

Parent/Guardian Email *

Additional Contact Details

Ad Contact Name *

Ad Contact Address *

Ad Contact Home Phone

Ad Contact Mobile Phone *

Ad Contact Email *

Medical and Learning Information

Medical Conditions * Does the above named student suffer from any medical conditions?

Medical Conditions - If Yes please provide details

Medication * Does the student take any medication that we should be made aware of?

Medication - If Yes please provide details

Medical Allergies * Does the above names student have any medical allergies we should inform the medical emergencies of. e.g. plasters, penicillin etc.

Medical Allergies - If Yes please provide details

Food Allergies * Does the above named student suffer from any food allergies?

Food Allergies - If Yes please provide details

Learning Difficulties * Has your child got any learning difficulties that we should be made aware of?

Learning Difficulties - If Yes please provide details

First Aid * In the event of an injury we give permission for first aid to be carried out on the above named student .

Any Other Information

GP Details *

Other Information

Photos and Videos *

PopRoX will from time to time take photographs and videos. These may be used for marketing purposes (e.g. website and newspapers). If you do not wish photographs of your child to be used please tick the box NO otherwise YES. Images will not be linked to Student names.

Trips *

Please check YES if you are happy for your child to be taken to outside venues with PopRoX - supervised (e.g. Competitions and Shows). You will be informed of any outside events prior to them taking place.

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ENROLMENT CONTRACT

Terms and Conditions

Parties

This contract is between the Parent/Legal Guardian named on the contract (“you” “us” or “your”) and PopRoX Rock and Pop Workshops ("PopRoX" or “we” or “our”). By signing this agreement the Parent/Legal Guardian undertakes that they and the student named on the contract will abide by the terms of this contract, and these terms of conditions form part of that contract.

The Course

PopRoX will provide Rock and Pop Workshops, to include discipline specific, group tutorials and band workshops plus any relevant supporting material, at the requested PopRoX Centre.

Fees and Payment

The course fee covers the provision of any relevant teaching by us for the 10 week workshop period or part thereof. Payment of the course fee is required in full before the specified start date, unless otherwise agreed.
We are under no obligation to refund or transfer the course fee in the event that the student is unable to attend part of, or the entire course. We also regret that we are unable to offer an alternative for missed lessons unless the missed attendance has been caused by us, or has been agreed by your Centre Manager. Any decision in relation to this would be made at the Centre Manager’s discretion. If a venue is not available or a lesson cannot be provided for any other reason, we will, where possible, reschedule the lesson. If for any reason the workshop needs to be re-located, we will not be liable for any additional travel expenses incurred. In the event of us having to cancel the lesson we will issue a credit note against next term’s course fee or, if a student will not be continuing, we will refund accordingly.

We may at our discretion refuse entry to any student. Where one of our Tutors has been subject to abusive behaviour, including verbal abuse or major disruption, and we are not obliged to issue any refunds for either the lesson, or the term.

Tutors

It is our policy that, whilst we try to ensure students are always taught by the same Tutor for continuity, we cannot guarantee this; as Tutors may fall ill or leave. Unfortunately we cannot give advance warning when this may happen and, whilst we will always try to limit any student inconvenience, it is sometimes unavoidable. However, we guarantee that the replacement Tutor will be to the same high standard to that of the usual Tutor.

Data Protection

All of the information contained within this contract will be held and processed in accordance with the Data Protection Act 1998. We will not disclose any of the information contained within this document to third parties for marketing purposes; however we may use this information to provide you with marketing information ourselves. By signing this contract you are providing us with your consent for us to the use of such personal data for the above purposes.

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Declaration * Agree

By checking this box. I agree that I have read and agree to the terms set out in the Enrolment Contract on behalf of myself and the student named above and that we will abide by the Terms and Conditions set out above.

We Agree To: * Agree

All students and parents must agree to the following:-
- It is essential that all students are dropped off and picked up promptly from lessons.
- Students must wear appropriate clothing.
- Bad Language and Behaviour will not be tolerated from any students/parents.
- We will not tolerate any form of bullying, harassment, racism or acts of violence.

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Signature * Please type your name here. By adding your name and submitting this form you agree you are authorised to do so, that all the information provided is true and correct and agree to all the terms herewith.

Date *

If the form is filled out correctly when you press submit you will be redirected to our main site and an email confirmation of the details submitted sent to you.

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PopRoX Rock and Pop Workshops is a trading name of MiaCon Ltd | Registered in England and Wales: 71300679 | Registered address: Chancery House, 30 St Johns Road, Woking, Surrey GU21 7SA

PopRoX Rock and Pop Workshops

Teaching intruments with music you love.

Enrolment and Consent Form

Student Details

Parent/Guardian Details

Additional Contact Details

Medical and Learning Information

Other Information

ENROLMENT CONTRACT

Terms and Conditions

Parties

The Course

Fees and Payment

Tutors

Data Protection