Enrolment Form

Please fill a separate enrolment form out for each student you are enrolling.

Enrolling for Term:
Student First Name:
Student Last Name:
Year at School:
Parent / Caregiver 1 Name:
Parent / Caregiver 2 Name: (if required)
Address:
Suburb:
Postcode:
Home Phone:
Parent Mobile No:
Parent Email:
Student Mobile:
Class 1:
Class 2:
Class 3:
Emergency Contact Name:
Emergency Contact No:
Medical Conditions (eg allergies, asthma):
Have you had any prior experience with this class? If so, outline here:
Permission to use your child’s photo for UpStage promotional purposes:
I have read and agree with the Terms & Conditions document.

 

If you wish to pay by credit card, please complete the section below:

Card Type:
Name on card:
Card No:
Expiry:
Amount Paid:
Card CCV:
 
Verification code:
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