Student Name
*
First Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
Date
Current Year
*
Year 9
Year 10
Year 11
Year 12
Current School
*
Parent/Guardian Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
Suburb
State
Post Code
Telephone Number
*
Email
*
example@example.com
Why Are You Looking to Enrol Your Child in a CARE School?
*
Submit
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