A black background with the word academy written in white.

Home
Who we are
What we do
Events
Register
Registration Form
Contact

Home
Who we are
What we do
Events
Register
Registration Form
Contact

Registration Form

Please complete this form in BLOCK CAPITALS and return in person, by post or by email to the
above address. For further enquiries, kindly contact us. Thank you.

SECTION ONE

Candidate’s Personal Details:

First Name:

Surname:

Gender:

M

F

D.o.B.:
MM slash DD slash YYYY

Start Date with Salem:
MM slash DD slash YYYY

Home Address:(Required)
Street Address Address Line 2 City State Post Code:

Email Addr:(Required)

Tel:(Required)

Parent(s)/Carer(s) Name:(Required)

Parent(s)/Carer(s) Tel:(Required)

Parent(s)/Carer(s) Email:(Required)

Name and Address of your School:(Required)
Street Address Address Line 2 City State Post Code:

Type of School: Maintained/Independent (please circle) Borough of School:(Required)

School Email:(Required)

School Tel:(Required)

Are you receiving any music tuition at school? Y/N(Required)

Yes

No

If yes, state on which instrument:(Required)

on which day(s) Mon, Tue, Wed, Thurs, Fri; and how many hours per week?(Required)

Does your school enter you for music exams? Y/N(Required)

Yes

No

If yes, with which exam board(Required)

which grade:(Required)

and on which instrument, voice or theory?(Required)

Do you attend a music school (such as CYM)? If so, which one?(Required)

Address
Street Address Address Line 2 City State Post Code:

Which instrument do you wish to learn at Salem Academy of Music?(Required)

How did you hear about us?(Required)

SECTION TWO

A. Equal Opportunity
Equal Opportunity Monitoring: To which ethnic group do you belong? (for monitoring purpose only):

Equal Opportunity Monitoring: To which ethnic group do you belong? (for monitoring purpose only):(Required)
11 Asian/Asian British – Bangladeshi
12 Asian/Asian British – Indian
13 Asian/Asian British – Pakistani
14 Asian/Asian British – Any Other
Black/Black British – African

Equal Opportunity Monitoring: To which ethnic group do you belong? (for monitoring purpose only):(Required)
16 Black/Black British – Caribbean
17 Black/Black British – Any Other
18 Chinese
19 Mixed – White & Asian
20 Mixed – White & Black African

Equal Opportunity Monitoring: To which ethnic group do you belong? (for monitoring purpose only):(Required)
21 Mixed – White & Carr
22 Mixed – any other
23 White - British
24 White - Irish
98 Any Other
99 Do not wish to supply

B Employment Status –

to be completed by parents/Carer (this section is required by our funders)

Please indicate your employment status:(Required)
Employed
Self Employed
In Full Time Education
Unemployed
None of the above

Please tick as many boxes as are applicable to your circumstances:(Required)
Job Seekers Allowance
Working Tax Credit (Household income less than 18,000 only)
Income support and other income-based benefit
House/Council Tax Benefit Asylum Seeker (receiving equivalent of income-based benefit)
Unwaged dependant of someone in any of the above categories

SECTION THREE

Other Relevant Information –
Please use the space below to inform us of any information you think might be relevant in your application (attach a separate sheet if necessary):

Declaration:

I declare that to the best of my knowledge, the information that I have provided is correct, and that should my circumstances change I will notify the Academy. I understand to attend regularly and be punctual to the lessons and to abide by the rules and regulations of the Academy.

Student Signature(Required)

Date(Required)
MM slash DD slash YYYY

Parent/Carer Signature:(Required)

Date(Required)
MM slash DD slash YYYY

For Office Use Only

Aural Test Result(Required)

Entry Grade:(Required)

Instrument Allocated:(Required)

Audition Interview 1:(Required)

Date(Required)
MM slash DD slash YYYY

Audition Interview 2:(Required)

Name
This field is for validation purposes and should be left unchanged.

Contact us

Get in touch for further information, donations, or just to share your thoughts. We’d love to hear from you.

Name(Required)
First Last
Email(Required)

Phone
Comments
Please let us know what's on your mind. Have a question for us? Ask away.

Contact details

+44 07853 819751 (Mobile)

+44 (0)207 639 8897 (Business)

info@salemacademyofmusic.org.uk

Get Social

YouTube

Terms and policies

Terms and Conditions
Privacy Policy
Safeguarding Policy
Data Protection Policy

×
Terms and Conditions
Privacy Policy
Safeguarding Policy
Data Protection Policy

© 2025 Salem Academy Of Music