Enrolment and Consent Form

PopRoX Consent Form and Enrolment Contract

Once you have heard from us and we have confirmed your place at PopRoX, please fill out the Consent Form and Enrolment contract below.

Consent Form

Student Details

Please only enrol another sibling on this form if all the details are exactly the same. If anything differs such as medical conditions then please fill out a new form.

Please Note ..

This form is to be completed by the Parent or legal Guardian of the above named student. Please ensure all fields are completed. Also ensure you provide an emergency contact number and at least one other additional emergency contact.

Parent / Guardian Details

This e-mail address will be used for all correspondence

Additional Contacts Details

In the first instance we will try the parents contact information however we will also require a second emergency contact

Medical and Learning Information

Does the above named student suffer from any medical conditions?

Please specify

Does the student take any medication that we should be made aware of?

Please specify

Does the above names student have any medical allergies we should inform the medical emergencies of. e.g. plasters, penicillin etc.

please specify

Does the above named student suffer from any food allergies?

Please specify

In the event of an injury we give permission for first aid to be carried out on the above named student .

Has your child got any learning difficulties that we should be made aware of?

Please specify

Other Information

PopRoX will from time to time take photographs and videos. These may be used for marketing purposes (e.g. website and newspapers). If you do not wish photographs of your child to be used please tick the box NO otherwise YES. Images will not be linked to Student names.

Please check YES if you are happy for your child to be taken to outside venues with PopRoX - supervised (e.g. Competitions and Shows). You will be informed of any outside events prior to them taking place.

Enrolment Contract

Terms and Conditions


This contract is between the Parent/Legal Guardian named on the contract (“you” “us” or “your”) and PopRoX Academy ("PopRoX" or “we” or “our”). By signing this agreement the Parent/Legal Guardian undertakes that they and the student named on the contract will abide by the terms of this contract, and these terms of conditions form part of that contract.

The Course

PopRoX will provide Rock and Pop Workshops, to include discipline specific, group tutorials and band workshops plus any relevant supporting material, at the requested PopRoX Centre.

Fees and Payment

The course fee covers the provision of any relevant teaching by us for the workshop period or part thereof. Payment of the course fee is required in full before the specified start date, unless otherwise agreed.

We are under no obligation to refund or transfer the course fee in the event that the student is unable to attend part of, or the entire course. We also regret that we are unable to offer an alternative for missed lessons unless the missed attendance has been caused by us, or has been agreed by your Centre Manager. Any decision in relation to this would be made at the Centre Manager’s discretion. If a venue is not available or a lesson cannot be provided for any other reason, we will, where possible, reschedule the lesson. If for any reason the workshop needs to be re-located, we will not be liable for any additional travel expenses incurred. In the event of us having to cancel the lesson we will issue a credit note against next term’s course fee or, if a student will not be continuing, we will refund accordingly.

We may at our discretion refuse entry to any student. Where one of our Tutors or another Student has been subject to abusive behaviour, including verbal abuse or major disruption, and we are not obliged to issue any refunds for either the lesson, or the term.


It is our policy that, whilst we try to ensure students are always taught by the same Tutor for continuity, we cannot guarantee this; as Tutors may fall ill or leave. Unfortunately we cannot give advance warning when this may happen and, whilst we will always try to limit any student inconvenience, it is sometimes unavoidable. However, we guarantee that the replacement Tutor will be to the same high standard to that of the usual Tutor.

Data Protection

All of the information contained within this contract will be held and processed in accordance with the Data Protection Act 1998. We will not disclose any of the information contained within this document to third parties for marketing purposes; however we may use this information to provide you with marketing information ourselves. By signing this contract you are providing us with your consent for us to the use of such personal data for the above purposes.

By checking this box. I agree that I have read and agree to the terms set out in the Enrolment Contract on behalf of myself and the student named above and that we will abide by the Terms and Conditions set out above.

All students and parents must agree to the following. It is essential that all students are dropped off and picked up promptly from lessons. - Students must wear appropriate clothing - Bad Language and Behaviour will not be tolerated from any students/parents - We will not tolerate any form of bullying, harassment, racism or acts of violence.

Signature and Date

Please type your name here. By adding your name and submitting this form you agree you are authorised to do so, that all the information provided is true and correct and agree to all the terms herewith.

PopRoX Academy and Rock and Pop Workshops is a trading name of MiaCon Ltd | Registered in England and Wales: 71300679
Registered address: Chancery House, 30 St Johns Road, Woking, Surrey GU21 7SA
Please wait...