Galaxy Enrolment Form
Welcome to Galaxy!

This form will get us all the information we need to successfully enrol your child into classes.

Please be sure you check all information is correct and all classes are indicated for enrolment.
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Email *
Student FIRST Name: *
Student SURNAME:
Student Date of Birth (month-day-year) *
MM
/
DD
/
YYYY
Parent/Carer FIRST Name: *
Parent/Carer SURNAME:
Parent/Carer Mobile: *
Emergency Contact: please provide name and mobile number *
Address:
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