Enrolment Form
Please complete the following information to register your child for a Wildly Curious Term program. Your child(ren's) place will be confirmed once a space has been secured, you have fully registered and signed the Terms and Conditions. Please complete one form for each family member you are interested in enrolling. You will receive an email and payment options once the form has been processed and a place given.
Wildly Curious
'Nurturing Young Explorers through Education, Creativity and Adventure'
Child's Name
*
First Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
Date
Parents Name
*
First Name
Last Name
Contact Number
*
-
Area Code
Phone Number
Email address
*
example@example.com
Home address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact Name
*
First Name
Last Name
Emergency contact number
*
Please enter a valid phone number.
Which day/s are you registering your child for?
*
Term 2 Tuesday Age 4 - 10
Term 2 Wednesday Age 4-10
WAITING LIST Term 2 Thursday Age 5-12
Term 3 Tuesday 4 - 10
Term 3 Wednesday 4 - 10
WAITING LIST Term 3 Thursday 5 - 12
Term 4 Tuesday 4 - 10
Term 4 Wednesday 4 - 10
WAITING LIST Term 4 Thursday 5 - 12
Please state if your child has any medical conditions / allergies (including food) or any other information that you feel we should be aware of:
Tick here if you are interested in the Wildly Curious Learning Lab Tutor sessions. Tuesday or Thursday session 9.00am - 11.30am for ages 5 - 12. Children will embark on exciting journeys of discovery through the realms of literacy, numbers, and scientific inquiry, all within the context of their outdoor environment. More information will be sent to you if interested. These sessions are for children who are enrolled in the full day term sessions.
Yes
No
Why would you like your child to attend our sessions?
*
What are your child’s strengths and talents?
*
Do you have any concerns about your child at this time; social, behavioural, learning? Please be honest in your answer. If your child needs one on one assistance you will need to either accompany them or provide support for them.
What are your child’s main interests and activities?
*
Is there anything else that would be helpful for us to know about your child? For example do they have a behavioural or learning diagnosis?
Current Teacher's information
First Name
Last Name
School or Pre-school Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Current Teacher's Email
example@example.com
Disclaimer: I understand that I need to sign a Consent to Participate and a Terms and Conditions form in order for my child to participate at the Wildly Curious Centre. This will be sent to me once my child has been accepted into the program. I understand that my child's place is not secure until I have paid the cost of the sessions in full. I also understand that my child will not be supervised by Wildly Curious until the agreed start time, when Wildly Curious will take over supervision.
*
I agree
Signature
*
Submit
Should be Empty: