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Junior Class Registration Form 2022
Please fill out your details below and submit before attending a class at Pol-arise Newcastle. Students may not participate in class until we receive this completed form.
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* Indicates required question
Email
*
Your email
Child's First Name
*
Your answer
Child's Surname
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Parent/Guardian - Full Name
*
Your answer
Parent/Guardian - Phone number
*
Your answer
(Optional) Second Parent/Guardian - Full Name
Your answer
Second Parent/Guardian - Phone number
Your answer
Street Address
*
Your answer
Suburb & Postcode
*
Your answer
Emergency Contact Name
*
Your answer
Emergency Contact Phone Number
*
Your answer
Does your child have any medical conditions, learning difficulties or other considerations we should be aware of?
*
Your answer
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