YMA Futuwwah After-school program
Student Enrolment to be completed by a parent/guardian aged 18 and over.
11 Walker Street, Dandenong
Student Information
Personal information about the Student enrolling.
Name
*
First Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
Date Picker Icon
Gender
*
Please Select
Male
Female
Address
*
Street Address
Street Address Line 2
Suburb
State
Post Code
School Class
Please Select
Prep
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Year 7
Year 8
Year 9
Year 10
Year 11
Year 12
Tertiary/Other
This is your year level at School (Mon-Fri) for the current academic year
Medical Conditions
It is essential that staff are aware of any medical conditions your child may have to best cater for them.
Does your child have any diagnosed Medical conditions?
*
This includes diagnosed learning or behavioural conditions.
Does your child have any special dietary requirements?
Medicare Number
*
Parent / Guardian / Next of Kin Details (1)
Information about a parent/guardian/next of kin for the student (must be aged 18 years and older)
Name
*
First Name
Last Name
Mobile Number
*
E-mail
*
example@example.com
Relationship to student
*
Address
*
Street Address
Street Address Line 2
Suburb
State
Postcode
Photography & Film Permission
For purposes of documentation, marketing, and evaluation, it is necessary to take photos/videos of students. Images may be used for printed publicity, online and social media activities. We will not use the student's image without your consent.
Photography & Filming Permission
*
Please Select
I give photo / film consent
I do not give photo/film consent
Declaration
By ticking the box below you are agreeing that the above information is correct and you will inform YMA Weekend School of any changes to details.
To be completed by a parent / legal guardian.
*
I agree that the above information is correct.
Session enrolment
Payment of fees is a requirement to secure your child's enrolment. If you require financial assistance, please contact admin team.
Sessions
*
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Qur'an Lessons
Monday and Wednesday 4:15pm-5:15pm
$
199.00
AUD
Archery Program
Wednesdays 5:15pm-6:15pm
$
129.00
AUD
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1
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9
10
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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