Enrolment Form

Parents Name*

First NameLast Name

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Contact Phone Number*

Child's Name*

First NameLast Name

Date of birth

Date

Gender*

Emergency Contact*

First NameLast Name

Emergency Contact Phone Number*

Intended year of enrolment at Master Minds EDU*

20252026

Choice of Program*

Brilliant MindsYoung GeniusesFast Thinkers1 ON 1

School Readiness Preferred day*

TuesdayWednesdayThursday

Intended year to commence Primary*

Number of years in preschool setting prior to year of enrolment at Master Minds EDU*

Specific Learning Needs (e.g., Speech, OT)*

Any Medical Conditions? (e.g., Asthma, Allergies)*

Any Behavioral concerns*

I hereby give consent for Master Minds EDU to use, retain or reproduce photographs and advertisements produced by Master Minds EDU.

I agreeI disagree

I have read and accepted the terms and conditions including the fee schedule and cancellation policy. It is at the discretion of the Master Minds staff to withdraw my child from class if payment is not received by the due date. Make up classes are based upon availability and may not be transferred from one term to the next.

I have read and accepted the emergency procedures. I understand my child will receive medical treatment in the case of an emergency. If parent contact is unsuccessful, the emergency contact listed in this document will be contacted on behalf.