AussieRead expression of interest

Registration for AussieRead
Please complete the form form below and I will contact you to enrol your child in AussieRead.
Your child's first and last name*

First nameLast name
Date of birth*

DayMonthYear
Please tick off all the days your child is available after school (after 3:30 pm)

MondayTuesdayWednesdayThursdayFriday
Where do you live?*

Street Address

Street Address Line 2

CityШтат

Zip CodeCountry
Please leave your email address so that I can contact you*
example@example.com
Please leave your mobile number so that I can call you*
Is there anything else I need to know about your situation or your child?
How did you hear about AussieRead?

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Registration for AussieRead