STUDENT REGISTER
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.
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
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 these sessions?
*
Yes
No
If yes, please explain further
Does your child have any allergies or dietary restrictions? (For our Food Technology workshop)
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
How did you hear about ESHS XCELERATE Academy?
*
Social Media
Information from your Primary School
Academy Information Session
Sibling currently attends ESHS
Attended Immersion Day
Other
Emergency Contact
*
First Name
Last Name
Emergency Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Submit
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