The Book of Purification Enrolment Form 2019

The Book of Purification Course

Student Enrolment to be completed by a parent/guardian aged 18 and over.
Have you previously attended YMA Weekend School? *

Yes No
Student Information

Personal information about the Student enrolling.
Name *

First Name Last Name
Date of Birth *

Day Month Year Date Picker Icon
Gender *

Address *

Mobile Number *
Student mobile number (Or the best contactable mobile number that may be added to the Student Whatsapp group setup for this course).
E-mail *
Student Email Address
Name of academic School/University *
School Class/ University Year *
Year currently undertaking in 2018
Medical Conditions

It is essential that staff are aware of any medical conditions your child may have to best cater for them.
Do you have any diagnosed Medical conditions? *
Do you have any special dietary requirements?
Medicare Number *
Emergency Contact

Information about a parent/guardian/next of kin for the student (must be aged 18 years and older)
Name *

First Name Last Name
Relationship to student *
Mobile Number *
Phone Number

Area Code Phone Number
E-mail

Address *

Photography & Film Permission

For purposes of documentation, marketing, and evaluation, it is necessary to take photos/videos of students. Images may be used for printed publicity, online and social media activities. We will not use the student's image without your consent.
Photography & Filming Permission *
Declaration

By ticking the box below you are agreeing that the above information is correct and you will inform YMA Weekend School of any changes to details.
To be completed by a parent / legal guardian. *

I agree that the above information is correct.
Fees

Payment of fees is a requirement to secure your enrolment.

Please choose from one of the following payment options *

Course fee $ 85.00 AUD

Total $ 0.00 AUD

The Book of Purification Course