2024 Enrolment Form

2025 Enrolment Form - Junior

Years 7-10
Student Information

Please enter your child's information below.
Student Name*

First NameLast Name
School Year*
School Name*
Gender*
Birth Date*

DayMonthYear
Student Mobile*
Student Email*
Address*

Street Address

Street Address Line 2

SuburbState / Province

Postcode
Parent/Guardian Information

Please enter your information below.
Primary Guardian Name*

First NameLast Name
Primary Guardian Mobile*
Primary Guardian Email*
Secondary Guardian Name

First NameLast Name
Secondary Guardian Mobile
Secondary Guardian Email
Acknowledgement

Please read and agree to the terms below.
I, the parent/guardian will make every effort to uphold the allocated time for tuition. However, if less than 24 hours notice is given, I understand that the session fee will still apply.*

Agree
I understand that while every effort will be made to keep the same tutor for every session, there may be a temporary or permanent change in tutor.*

Agree
I understand that my child may be photographed/videographed for marketing purposes. I also understand that Cortex Education will remove these photos/videos upon my request.*

Agree
Name*

First NameLast Name
Date*

DayMonthYear
Signature*

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2025 Enrolment Form - Junior