2024 Enrolment Form

2026 Enrolment Form - Senior

Years 11-12
Student Information

Please enter your child's information below.
Student Name

First NameLast Name
School Year
School Name
Gender
Birth Date

DayMonthYear
Student Mobile
Format: 0000 000 000.
Student Email
Address

Street Address

Street Address Line 2

SuburbState / Province

Postcode
Student Subjects

Please select your child's subjects below.
English
Mathematics
HSIE
Science
Technologies
Creative Arts
PDHPE
Languages
E.g. Modern Greek Beginners or French Continuers etc.
VET
E.g. Construction or Hospitality etc.
Parent/Guardian Information

Please enter your information below.
Primary Guardian Name

First NameLast Name
Primary Guardian Mobile
Format: 0000 000 000.
Primary Guardian Email
Secondary Guardian Name

First NameLast Name
Secondary Guardian Mobile
Format: 0000 000 000.
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.
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.
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.
Name

First NameLast Name
Date

DayMonthYear
Signature
Should be Empty:

2026 Enrolment Form - Senior