Penrith Con

LiveWire Band - Application Form

Applicant Information

First Name

Last Name

Email

Mobile Number

Date of Birth

Postal Address

Street Address

Suburb

State

Postcode

Instrumental Information

Instrument

Performance Grade

Performance / Musical Experience

Emergency Contact

First Name

Last Name

Phone/Mobile

Email

Agreement

By enrolling in a Penrith Con Ensemble, you:

Authorise staff of Penrith Performing & Visual Arts Ltd. to seek out emergency medical attention on your behlaf in the event of an emergency.

Understand that Penrith Con Ensemble staff and tutors accept no responsibility for the supervision of participants outside official session times.

Agree to indemnify Penrith Performing & Visual Arts Ltd. and its staff against any personal loss, injury or damage to property that may result from participating in the course or sessions, except when Penrith Performing & Visual Arts Ltd. is negligent or otherwise at fault.

Consent to be photographed and / or recorded during Penrith Conservatorium Ensemble sessions and related activities for the purposes of promoting Penrith Conservatorium now and in the future.

I agree