Holiday Program Enrolment Form

Holiday Program Enrolment Form

Enter your details, choose the subjects and session times, and share your child’s needs and goals.
Student Name

First NameLast Name
Parent Name

First NameLast Name
Parent Email
example@example.com
Parent Phone
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Which subjects are you interested in for your child?
Availability
Please tick as much availability as possible so we can find the best possible time. You can do as many sessions as you like. We recommend a minimum of 3-5 sessions for maximum benefits.
Which week(s) are you available? Please also indicate which centre you can attend.

Select all time slots your child is available for sessions:

Does your child have NDIS funding and will you be claiming lessons? (We are able to claim lessons under Capacity Building)
Specific areas in need of further support (please be as detailed as possible)
What are your child’s interests and strengths?
What would you like to achieve with our holiday intensive program? Please note anything you would like us know.
Should be Empty: