JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
October Holiday Drama Workshops 2019
Postal and Studio Address: 17 Badgery Avenue, Homebush, NSW, 2140
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Student Name:
*
Your answer
Home Address:
*
Your answer
Date of Birth:
*
Your answer
School Attended:
*
Your answer
School Grade:
*
Your answer
Enrolment:
*
Concord High School 3 day drama workhshop Wednesday 9th - Friday 11th October
Fees:
*
Early Bird Pay before 27th September $220 per child (includes video valued at $40)
Early Bird (with friend or sibling) Pay before 27th September $210 per child (includes video valued at $40)
Full fee after 27th September $240 per child
PARENT / GUARDIAN INFORMATION
Mother/Father or Guardian's Full Name:
Your answer
Contact Ph / Mobile:
Your answer
Contact Email:
Your answer
In case of Emergency:
Name:
Your answer
Contact Ph / Mobile:
Your answer
Does your child have any medical condition / impairment / disability you feel we should be informed about:
Your answer
Does your child suffer from Asthma?
*
Yes
No
Does your child have any food allergies or intolerances?
*
Yes
No
If yes, please advise:
Your answer
Does your child have any other allergies?
*
Yes
No
If yes, please advise:
Your answer
IN CASE OF EMERGENCY, I give The Hennessy Speech and Drama Studio permission to call an ambulance and understand I must meet any costs incurred. I am aware that Kidz on Stage will make every effort to contact me or an emergency contact as listed on this form.
*
Yes
No
I give permission for photographs of my child or video footage, taken in class, to be used in promotions, advertisements and information packages (eg. On our website, for newspaper advertisements and on promotional fliers).
*
Yes
No
PAYMENT OPTIONS accepted:
*
Choose
Internet - EFT The Hennessy Speech and Drama Studio BSB 302 162 Account 0402266
Cheque/Money order payable to The Hennessy Speech and Drama Studio
Fee amount Enclosed:
*
Your answer
How did you hear about us?
Friends
School
Word of Mouth
Facebook
Google Search
Other
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Rachel Hennessy.
Report Abuse
Forms
