my sounds sign up Order Number (page 1) First Name * Last Name Address Address2 Town Postcode Email * Phone Date of Birth * (page 2) Gender Male Female Nonbinary Male Transgender Female Transgender Prefer not to say Cultural Background White - British, English, Northern Irish, Scottish, Welsh White - Irish White - Gypsy, Roma or Irish Traveller White - European White - Any other White background Mixed / Dual heritage - White & Black Caribbean Mixed / Dual heritage - White & Black African Mixed / Dual heritage - White & Asian Mixed / Dual heritage - Any other Mixed/ Dual heritage background Asian / Asian British - Indian Asian / Asian British - Pakistani Asian / Asian British - Bangladeshi Asian / Asian British - Other Asian Background Arab Black / African - African Black - British Black / Caribbean - Caribbean Black - Any other African / Caribbean background Jewish Prefer not to say Other Do you have any physical or mental health condition, or illnesses, or disabilities that affects your participation in music? Yes No Prefer not to say Tell us about any special medical or dietary needs we should know about. Parent or guardian's details: (if you are under 18 will contact them for consent for you to participate in my sounds. First Name Last Name Relationship Email Mobile (page 3) Tell us why you’d like to take part in my sounds? Tell us about any past experience in music? (music lessons, ABRSM/Trinity exams, ensemble experience etc) How did you hear about my sounds? I confirm that I will participate in at least four sessions during the project. * If you've made a video answer, please provide the URL here If you have any questions about this form, please contact Tamara Kohler (tamara@coma.org)
