CHANGE MAKERS IMMERSION DAY REGISTRATION
Wednesday 24th June 2026
Student Information
Student Name
*
First Name
Last Name
Parent Information
Parent Name
*
First Name
Last Name
Email Address
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Where is your child currently going to school?
*
Elanora State School
Palm Beach State School
Tallebudgera State School
Currumbin State School
Currumbin Valley State School
Ingleside State School
Caningeraba State School
St Augustine's Parish Primary School
Other
What year level is your child currently in?
*
Please Select
Year 4
Year 5
Year 6
Year 7
Year 8
Year 9
Year 10
Year 11
Year 12
Immersion Days are designed for current Year 5 students
Do you give media consent for images that may include your child to be shared on social media?
*
Yes
No
Does your child require additional support during this session?
*
Yes
No
If yes, please explain:
How did you hear about ESHS XCELERATE Academies Immersion Days?
*
Social Media
Flyer in mail
Information from your Primary School
Banner on School Fence
Other
Submit
Should be Empty: