Teaching Agreement –

Private Pupils (My Child)

This agreement is for private pupils who are under 18 years old and should be completed by the primary parent/carer. Click here if you’d like to select a different agreement.

Please enter your details into the form. After pressing Submit, you should see a confirmation message and receive a copy of your completed form by email. If not, please review the sections highlighted in red.

Pupil’s full name Pupil’s full name *

Pupil’s preferred first name Pupil’s preferred first name *

Pupil’s date of birth Pupil’s date of birth *

Pupil’s school/college Pupil’s school/college *

Pupil’s current school year Pupil’s current school year *

Pupil’s home address Pupil’s home address *

Primary parents/carer’s name Primary parents/carer’s name *

Relationship to pupil Relationship to pupil *

Primary parent/carer’s mobile number Primary parent/carer’s mobile number *

Primary parent/carer’s email address Primary parent/carer’s email address *

Does the pupil have any special educational needs that the teacher should be aware of? * Does the pupil have any special educational needs that the teacher should be aware of? *

Pupil’s mobile number Pupil’s mobile number (only provide if you consent to Jack contacting your child directly for lesson-related logistical purposes, e.g. travel delays)

Pupil’s email address Pupil’s email address (only provide if you consent to Jack emailing your child directly to share practice resources or updates)

Terms & Conditions Terms & Conditions I confirm that I have read and agree to the Terms & conditions for private pupils as outlined at jackwbmusic.com/terms. I understand that this agreement becomes binding upon submission and remains in effect until terminated in accordance with the ‘Termination of Tuition’ clauses specified. I acknowledge that I am responsible for reviewing any updated terms each time a new invoice is issued.

Media consent Media consent I grant permission for Jack to make video and audio recordings of my child in lessons for home practice purposes. I understand that these recordings will be deleted from Jack’s device as soon as they have been sent to me.

GDPR consent GDPR consent I understand that my details will be used solely for the administration of music lessons and may be shared with appropriate music examination boards where necessary. I understand my rights under UK data protection law, including the right to request access, correction, or deletion of my data at any time.

Direct communication consent Direct communication consent I DO NOT give consent for Jack to communicate directly with my child. I give my explicit consent for Jack to communicate directly with my child using the mobile number and/or email address provided above, for lesson-related purposes only (e.g. practice resources, scheduling, travel updates). I understand that, due to practical circumstances, I may not always be copied into these communications, and I consent to this. I acknowledge that no social media communication will take place, and that all communications will remain strictly professional and safeguarding compliant. I understand I can withdraw this consent at any time by contacting Jack.

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