New Student Registration Form

1
Parent/Guardian Full Name* This field is required.
First Name
Last Name
2
Child Full Name* This field is required.
First Name
Last Name
3
Child Date of Birth* This field is required.
4
Phone Number* This field is required.
Area Code
Phone Number
5
E-mail* This field is required.
example@example.com
6
Does your child have any medical conditions we need to be aware of? e.g. allergies, asthma
7
Is there anything else we need to know about your child to help them have a positive experience in class?
8
Do you have any other questions?
9
I understand that after submitting this form my child will be booked into class from 3-4pm beginning in week 1 of Term 4 (October 17)
Yes
10
Payment9 week dance term $15 per lesson
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My Bag
1
My Bag
Great Product Name
$20
Quantity:1
Size:Small
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Great Product Name
$20
Quantity:1
Size:Small
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Great Product Name
$20
Quantity:1
Size:Small
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Great Product Name
$20
Quantity:1
Size:Small
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ORDER SUMMARY
Total costAUD
Campbell Primary School Term 4 Classes9 week dance term $15 per lesson
$135.00AUDEdit
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First Name
Last Name
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