Artists Registration Form s1

Plymouth Music Zone Ltd.

Brickfields

Raglan Road

Devonport

Plymouth

PL1 4NQ

www.plymouthmusiczone.org.uk

MUSIC LEADER REGISTRATION FORM

Name:

Address:

Town:

County: Postcode:

Tel: Mobile:

Email:

Website:

Where can you work?

Devon Plymouth

All of the South West

Types of music workshop you are already able to facilitate (Please tick more than one if necessary)

Percussion Song Writing Rock & Pop

Composition Ensembles Band Development

Singing and Vocals Curriculum

Music Technology Urban

Other (please specify)

Preferred age group? (Please tick more than one if necessary)

0-5 years 11-16 years 18 years plus

5-11 years 16-18 years Over 60’s

Preferred group size? (Please tick more than one if necessary)

1:1 Less than 10 Less than 30

Less than 50 50-100 100 plus

Have you had any experience of working with children or vulnerable adults, either in group workshops or with 1:1 sessions? Please describe.

Have you had experience of working with people with special needs/disabilities?

Yes No

Describe any training or experience in this area if applicable.

What sort of work do you currently do? What would you like to do with Plymouth Music Zone? What other skills do you have that you could bring to Plymouth Music Zone?

Qualifications

Please tell us what relevant qualifications you have (including where you studied and grades or levels achieved)

Do you have a Teaching certificate/ PGCE? Yes No

Give details

Do you have any other relevant training/CPD completed in the last 3 years, e.g. Child Protection, Equal Opportunities, Health & Safety, First Aid

References

(Please supply a professional reference and a personal reference)

Name / Name
Position / Position
Organisation / Organisation
Contact number / Contact number
Email address / Email address
Address / Address
Postcode / Postcode

Additional Information:

Is there any other information that you feel would be helpful for us to know?

If possible, please provide us with: Enc

Any audio recordings / images that represent your work (these can be

CDs / DVDs / photographs, flyers, drawings or scanned pictures)

Please let us know if your details change.

As part of Plymouth Music Zone’s Data Protection Policy, your information will only be used for our recruitment purposes and will not be passed on to any third party.

Declaration

I declare that to the best of my knowledge the information above is true and accurate and I am eligible to work in the United Kingdom.

I acknowledge that any offer of employment is made subject to an enhanced DBS check.

Signed