Home School/Social Group Program

Child's Details

Given Name *

Last Name *

Sex

Date of Birth *

Place of Birth *

Parent Details

Name *

Relationship to child *

Phone Number *

Email Address *

Home Address

Which Program Are You Interested In?

Start Date *

Do you have any special requirements?

NoYes

Funding

Please state the special requirements

Food Allergy/Requirements

Upload birth certificate or other documents

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I agree to maintain the payment of my fees using the centre’s fee processing systems and policies. *

I agree to abide by the Centre Policies and Procedures, in the Parent Information and Centre Policy books. *

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