Instrumental Music Program participation

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The Department of Education and Training, through Pacific Paradise State School, is collecting personal information in accordance with Education (General Provisions) Act 2006 to maintain records matching students with musical instruments. The information will only be accessed by Department of Education and Training. The information will not be given to any other person or agency unless consent is provided.

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Instrumental Music Program - Participation agreement form

Full name of student *

Year level *

I wish to participate in the Instrumental Music Program at Pacific Paradise State School in 2018. I have read and understand the terms and conditions of the program and agree to abide by them and to pay the relevant fee in accordance with the selected payment arrangement below. *

Yes, I would like my child to participating in string instrument program.

Yes, I would like my child to participating in brass/woodwind/percussion instrument program.

Instrument hire *

Yes. I wish to hire an instrument and understand the terms and conditions as set out in the Instrument Loan Agreement. I have completed a loan agreement form. ($120 including program and hire fee)

No. I do not wish to hire an instrument and have my own instrument to use during the program. ($80 program fee)

Parent/Carer name *

Parent/Carer email *

Parent/Carer preferred phone contact number *

Date *

Payment (multiple boxes can be checked) *

I will be paying the full amount by the due date as detailed.

I would like to use existing credit towards this payment.

Please deduct payments from Centrelink as per agreement.

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