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information sheet and Term 4 bookings
Please complete the folloiwng information sheet to update our records. All questions require an answer, if this does not apply please put N/A
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* Indicates required question
Email
*
Your email
Student name
*
Your answer
Primary Contact's Name + relationship (i.e. mother/father)
*
Your answer
Primary contact phone number
*
Your answer
Secondary Contact's Name + relationship (i.e. mother/father)
*
Your answer
Secondary contact phone number
*
Your answer
Student date of birth
*
MM
/
DD
/
YYYY
School Student attends
*
Your answer
School year
*
Your answer
Suburb you live in
*
Your answer
Medical issues - please indicate allergies or other diagnosed conditions
*
Your answer
Are you intending to book in for classes in term 4
*
No
Yes
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