Join the Netzer Perth Database
Shalom rav, please feel out this very brife form to join the Netzer Perth Database and get frequent information about our activities
Chanich/a's (Participant) Details
Name (first and Surname) *
Your answer
Year level at school *
Mobile number (if chanich/a has one)
Your answer
Email (If the chanich/a has one)
Your answer
Home phone number
Your answer
Parent/Guardian 1 details
Name *
Your answer
Preferred contact number *
Your answer
Email *
Your answer
Parent/Guardian 2 datails
Please answer in applicable
Name
Your answer
Preferred contact number
Your answer
Email
Your answer
Family address
Home address for the chanich/a *
Your answer
Alternative address (if applicable)
Your answer
Closing questions
If this their first involvement with Netzer *
How did they hear about Netzer *
Your answer
Any comments or questions
Your answer
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