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Please ensure you have read and understood the enrolment Terms and Conditions prior to completing this form.

I am enrolling in *
CLASS

STUDENT DETAILS
First Name *

Last Name *

Gender *
femalemaleother
Home Address *

Home Suburb *

Email *

Phone

Mobile

I agree to the terms and conditions of enrolment * Yes

MEDICAL OR SPECIAL NEEDS
Please note: Whilst a first aid kit is to hand, tutors cannot be responsible for the administration of medication or ensuring suitable health precautions are in place to suit all participants. Should tutors deem it necessary for an ambulance to be called, any costs will be incurred by the student or their guardian/parent.

Are there any medical or special needs the tutor should be aware of, including allergies?

Is the student required to carry medication? If so, provide details below.

I found out about StageFlight via: (hold down Ctrl key to select multiple)

Additional Comments:

IF STUDENT IS UNDER 18 ONLY
Parent/Carer Name *

Email *

Phone (this will be used to contact parent/carer in an emergency)

Mobile (this will be used to contact parent/carer in an emergency)

Student Year of Birth *

Student School Name

Year At School

In addition to me, the following people are authorised to collect my child after class:
Name 1: Phone:
Name 2: Phone:
Name 3: Phone: