Enrolment Form
Please complete the following information to register your child for a Wildly Curious Term program. Your child(ren's) place will be confirmed once a space has been secured, you have fully registered and signed the Terms and Conditions. There is a non-refundable $160 booking fee that is required to be paid before the term fee. Please complete one form for each family member you are interested in enrolling. You will receive an email and payment options for the booking fee once the form has been processed and a trial date has been agreed on.
Wildly Curious
'Nurturing Young Explorers through Curiosity, Creativity and Adventure'
Child's Name
*
First Name
Last Name
Date of Birth
*
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Day
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Month
Year
Date
Parents Name
*
First Name
Last Name
Contact Number
*
-
Area Code
Phone Number
Email address
*
example@example.com
Home address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact Name
*
First Name
Last Name
Emergency contact number
*
Please enter a valid phone number.
Which day/s are you registering your child for?
*
Term 1 2025 Tuesday Ages 4+
Term 1 2025 Wednesday Ages 4+
Term 1 2025 Thursday Ages 5+
Term 2 2025 Tuesday Ages 4+
Term 2 2025 Wednesday Ages 4+
Term 2 2025 Thursday Ages 5+
Term 3 2025 Tuesday Ages 4+
Term 3 2025 Wednesday Ages 4+
Term 3 2025 Thursday Ages 5+
Term 4 2025 Tuesday Ages 4+
Term 4 Wednesday Ages 4+
Term 4 Thursday Ages 5+
All 4 Terms Tuesday (Termly payments )
All 4 Terms Wednesday (Termly payments
All 4 Terms Thursday (Termly payments)
Please state if your child has any medical conditions / allergies (including food) or any other information that you feel we should be aware of:
What are your child’s strengths and talents?
*
Do you have any concerns about your child at this time; social, behavioural, learning? Please be honest in your answer. If your child needs one on one assistance you will need to either accompany them or provide support for them.
What are your child’s main interests and activities?
*
Is there anything else that would be helpful for us to know about your child? For example do they have a behavioural or learning diagnosis?
Current Teacher's information
First Name
Last Name
School or Pre-school Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Current Teacher's Email
example@example.com
Disclaimer: I understand that I need to sign a Consent to Participate and a Terms and Conditions form in order for my child to participate at the Wildly Curious Centre. This will be sent to me once my child has been accepted into the program. I understand that my child's place is not secure until I have paid the booking fee and the cost of the sessions in full. .
*
I agree
Signature
*
Submit
Should be Empty: