WHS Adult Harmonium Enrolment Form West Wing

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WHS Enrolment Form West Wing

First Student Name (First Names and Surname) *

First Student Date of Birth

YYYY

First Students Sex

Female

Male

Prefer not to say

Clear selection

Address *

Phone (Home)

Mobile *

Email *

Previous School(s) attended for Harmonium

Students self assessment according to own ability

Nill

Average

Good

Student 1

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Next of Kin (Name) *

Relationship to student *

Emergency Contact Ph. Number *

Please advise any Medical, Special Needs/ Allergies/ Disability (List for all students)

DECLARATION (to be accepted by all parents/ guardians of students below 18 and by students over 18 years)I, parent, guardian, of above named student or student over 18 years, hereby declare that the information provided above is correct. I further declare that if granted admission the above named student will abide by all the school rules and regulations. *

Agree

Required

Subs Paid ($40.00 per month, can be paid online A/C 060103017025600 - please put your name as the reference, to be paid monthly at the beginning of the month)

Yes

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Submit

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