TERM 1 2022 FABKids Student Registration Form

Student Name* This field is required.

First Name

Middle Name

Last Name

Student TWO - Name

First Name

Middle Name

Last Name

Primary email for class information on classes and scripts* This field is required.

example@example.com

Birth Date* This field is required.

Does your child have any learning or social challenges I should be aware of?

Phone Number* This field is required.

Please enter a valid phone number.

How did you hear about FABKids

Current Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Primary Emergency | Contact Name

First Name

Last Name

Primary Emergency | Phone Number

Please enter a valid phone number.

Primary Emergency | What is your relationship with the student?

Secondary Emergency | Contact Name

First Name

Last Name

Secondary Emergency | Phone Number

Please enter a valid phone number.

Secondary Emergency | What is your relationship with the student?

Please list any of the followings: current medications, medication allergies, food allergies, or chronic health concerns.

Any other relevant information you would like to add?

Classes | Packages | Products * This field is required.PRESS SUMIT OnLY ONCE TO AVOID DUPLICATE CHARGES -If you would like to pay via bank transfer please press submit below and email fabe@parrmanagement.com.au to be invoiced. Payment to be made before the commencement of the sessions. Thank You

First Name

Last Name

Would you like to have a chat about joining PARR Management - Kids Talent Agency?* This field is required.

Yes

No thanks - not at the moment

Already in the Agency