Junior Academy - Expression of Interest Term 4
Please fill this form out prior to attending each Junior Academy session so we know how many numbers to expect each night
Dates (Fridays)

October 2017 (2 sessions) - 20th & 27th

November (4 sessions) - 3rd, 10th, 17th & 24th

Participant's Full Name *
Your answer
Participant's Date of Birth *
MM
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DD
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YYYY
Participant's e-mail address (if applicable)
Your answer
Primary Contact (Parent/Guardian) Name *
Your answer
Primary contact e-mail address *
Your answer
Primary Contact number *
Your answer
Does the participant have any allergies/medical conditions? (Yes or no - if yes please explain) *
Your answer
Payment *
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