| Please complete the following details |
*Students Name | |
*Age | |
*D.O.B. (dd/mm/yy)
| |
*Address | |
*Suburb | |
*Postcode | |
*Parents Names | |
*Home Phone | |
Work Phone | |
*Mobile | |
Students Mobile | |
Other Contact | |
Contact Name | |
*Email | |
Student Email | |
Please list any medical conditions/injuries that teachers should be aware of: | |
*All pre-schoolers receive a lolly after class - will this be a problem for your child? | |
New Enrolments: How did you hear about us? | |
Please select which classes you would like to do in 2010 |
*Class 1 | |
Class 2 | |
Class 3 | |
Class 4 | |
Class5 | |
Class 6 | |
Class7 | |
Class 8 | |
Class 9 | |
Class 10 | |
*Registration | |
*Fees/Packages | |
Please enter the following Information so that a direct debit form can be prepared in advanced. Please note that by filling in these information fields you are not authorising a debit, a signed debit form is the only way we are authorised to take money |
*Surname | |
*Given Name | |
*Mobile | |
*Would you like an sms reminder? | |
*Debit Form | |
*Frequency | |
*Name of Financial Institution | |
*Branch | |
*BSB | |
*Account Number | |
*Account Holder Name | |
OR |
Credit Card Type | |
Expiry Date (mm/yy)
| |
Name of Cardholder | |
| Comments | |
|
