Enrolment Form
Parent / Guardian Full Name: *
Email Address *
Postal Address
Primary Phone: *
In case of an emergency, please name a contact and their relationship to the child(ren) (Name, Relationship, Phone Number):
Student 1 (Name, D.O.B, Program Level)
Student 2 (Name, D.O.B, Program Level)
Student 3 (Name, D.O.B, Program Level)
Medical Details:
Does your child suffer any allergies? If yes please give details
Any breathing disorders?
Any ear disorders?
Fainting/Dizzy spells?
If any of the medical conditions were selected please list which child has which the condition.
Acknowledgement and Consent:
Terms and Conditions
Electronic Signature (type name):
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