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    Student information












    YesNo

    Program Selection



    Parent/Guardian 1








    YesNo

    Parent/Guardian 2








    YesNo

    Program Details



    Monday

    Tuesday

    Wednesday

    Thursday

    Friday

    Saturday

    Sunday

    Morning
    Morning classes available 9am to noon

    Preference:

    Preference:

    Preference:

    Preference:

    Preference:

    Preference:

    Afternoon/Evening
    Afternoon classes available 12pm to 8:30pm

    Preference:

    Preference:

    Preference:

    Preference:

    Preference:

    Preference:

    Monday

    Tuesday

    Wednesday

    Thursday

    Morning
    Morning classes available 9am to noon

    Preference:

    Preference:

    Preference:

    Preference:

    Program Details

    Monday

    Tuesday

    Wednesday

    Thursday

    Friday

    Saturday

    Sunday

    Morning
    Morning classes available 9am to noon

    Preference:

    Preference:

    Preference:

    Preference:

    Preference:

    Preference:

    Preference:

    Afternoon/Evening
    Afternoon classes available 12pm to 8:30pm

    Preference:

    Preference:

    Preference:

    Preference:

    Preference:

    Preference:

    Preference:

    Program Details

    Monday

    Tuesday

    Wednesday

    Thursday

    Friday

    Saturday

    Sunday

    Morning
    Morning classes available 9am to noon

    Preference:

    Preference:

    Preference:

    Preference:

    Preference:

    Preference:

    Afternoon/Evening
    Afternoon classes available 12pm to 8:30pm

    Preference:

    Preference:

    Preference:

    Preference:

    Preference:

    Preference:



    Program Details


    Family Information







    YesNo

    Medical History






    DiabetesAnaphylaxisAsthmaEpilepsyAllergiesOther







    Please provide your local GPs details:





    Medical Information






    DiabetesAnaphylaxisAsthmaEpilepsyAllergiesOther








    Emergency Details

    If Parent/Guardian 1 and Parent/Guardian 2 cannot be contacted, please let us know who we should contact in the event of an emergency.

    Emergency Contact 1






    Emergency Contact 2







    Pick Up Authorisation

    Person/s who may pick up your child on a less frequent basis. Any person unfamiliar to our staff will be required to show identification and will not be allowed to collect your child without written and/or verbal permission from the parents/guardians.

    Authorised Pick Up Person 1






    Authorised Pick Up Person 2






    Acknowledgement