Glee Club for Kids - registration form Term 3/4 2022

Registration Form - Term 3/4, 2022
Parent name

First Name Last Name
Student name

First Name Last Name
Student 2 name (if more than one student in the family)

First Name Last Name
Birth Date (student 1)

Month Day Year
Birth Date (student 2)

Month Day Year
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
E-mail (please double check this)
example@example.com
Phone Number
Additional info, comments or questions
Payment - you can try out the first week for just $10 or fix up the term fees now
prev next ( X )
Giving it a go Come along for one week before deciding if it's for you
$ 10.00 AUD Quantity

Term fees (student 1)
$ 200.00 AUD

Term fees (student 2)
$ 180.00 AUD

Total

$ 0.00 AUD

Payment Methods

Debit or Credit Card

First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Please click one of the PayPal options to complete payment and submit the form.

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