Young patients programme

The RSF Young Patients Programme provides weekly, one-to-one music lessons to young patients referred to RSF by The Imperial College Health Trust. RSF and Imperial have been working together on this programme since 2020. These lessons can be in person at The Rhythm Studio, West London College, W14 9BL or via Zoom.

The duration of the programme is for a maximum of 12 months (approximately 36 lessons). If you would like to continue lessons after 12 months, you have the option either to pay for the lessons or if applicable, apply for a means-tested scholarship.

Young Patients Application

Please note that it is not possible to save this form and return to it later. We recommend that you print the form, prepare your answers, then complete and submit your application.

Applicant Details

Title

Name

First Name

Last Name

Date of birth

School

Address

PARENT / GUARDIAN DETAILS

Title

Name

First Name

Last Name

Home telephone

Mobile telephone

INSTRUMENT & INTERESTS

Primary Musical Interest

Secondary Musical Interest

if applicable

Outline you musical background, including experience, interests and ambitions.

Do you have any musical instruments at home?

Please specify below

Describe any extra-curricular music activities that you have been involved in during the last three years.

Do you have any additional needs we should be aware of?

I understand that the duration of the programme is for a maximum of 12 months

I understand that failure to attend my lessons consistently will result in my lessons being withdrawn

Declaration (to be completed by parent / guardian if the applicant is under 16.

I confirm that, to the best of my knowledge, all information given as part of this application is correct. I hereby grant The Rhythm Studio Foundation explicit consent to process my sensitive personal data as defined by the Data Protection Act 1998.

Completing The Application

Please complete each section of this form in full, carefully and clearly. Individual applicants under 16 may prefer to have their parents complete the form. However, please make sure that the form is completed in the child’s name. Parents will need to complete the declaration at the foot of the form if the applicant is under 16.

Application Queries

If you have any queries that are not covered in these instructions, or if you are in any way uncertain whether your application will meet The Foundation’s criteria please contact us before submission.