SEEN Drama
Student Enrollment Form
Student Details:
Full Name
*
First Name
Last Name
Gender
Date of Birth
*
-
Day
-
Month
Year
Date
Ethnicity:
Iwi:
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What are your child's interests? (This informs our planning)
Child's main education provider
Mainstream School
Northern Health School
Correspondence/Te Kura
Homeschool
What are your child's experiences and feelings of school:
Child's medical information:
*
Anything else that might be useful to know:
Parent Details:
Parent/Primary Contact
*
First Name
Last Name
E-mail
*
example@example.com
Phone Number:
*
Parent/Secondary Emergency Contact
*
First Name
Last Name
E-mail
example@example.com
Phone Number:
*
Class of Enrollment
*
Please Select
3.30 - 4.30 (Ages 5 - 9)
4.45 - 6pm (Ages 10 - 13)
How did you hear about us?
*
Please Select
Word of Mouth
Social Media
Google
Other
What do you hope your child gains from SEEN Drama?
*
Submit
Should be Empty: