Part Payment -Term 1, 2019

1

Your Name* This field is required

First Name

Last Name

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2

Child's Name* This field is required

First Name

Last Name

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3

Contact Email Address* This field is required

example@example.com

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4

Emergency Contact Phone Number* This field is required

Area Code

Phone Number

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5

Back-up Emergency Contact Phone Number (optional)

Area Code

Phone Number

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6

Child's Age* This field is required

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7

Is there any personal or medical information we should know about your child?

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9

From time-to-time we use children's images on our website and social media channels. Are you happy for your child's image to be used for this purpose?

YESNO

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10

Choose a payment method

Credit Card

Online Banking

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11

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12

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Enter

13