Enrolment

Personal Details
Child Name
Address
Contact Ph (Home)
Contact Ph (Mob)
Child's DOB
Parent/Caregiver Name
Email
Course Details
1. Class
Term (Select One)
- Term 1
- Term 2
- Term 3
- Term 4
Day & Time
Cost
2. Class
Term (Select One)
- Term 1
- Term 2
- Term 3
- Term 4
Day & Time
Cost
Payment
Credit Card
- Visa
- Mastercard
Credit Card Number
Name On Card
Expiry
I give permission for my child to attend the above classes. In the event of illness or injury I give permission for medical attention to be sought knowing I will be contacted as soon as possible.
- Confirm
Date
Date Format: MM slash DD slash YYYY

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Personal Details