Test Contact Form This is a 2 step process Step 1: Enrolment Step 2: Payment Enrolment Form Please enter the details below and press the SUBMIT FORM button to complete STEP 1 of the enrolment process. Student Details All fields marked with an asterisk(*) are compulsory Student Name* Date of Birth* Postal Address* Suburb* Postcode* Current School Attended* Current Year Level* Parent Details All fields marked with an asterisk(*) are compulsory Name of Parent/ Carer A Name of Parent/ Carer B Preferred Mobile Contact Number* Preferred Email* Is your child ready to kiss and go? Please SelectYESNO Are you ready to kiss and go? Please SelectYESNO Program Selection Would you please indicate your top two prefrences for the SHINE program in which you would like to enroll. Due to demand we cannot guarantee you will be sucessfull in your first choice Please visit OUR PROGRAMS for more information on our programs. 1st choice Select ProgramJunior Masterclass (5 – 7) Term 1Junior Masterclass (5 – 7) Term 2Junior Masterclass (5 – 7) Term 3Junior Masterclass (5 – 7) Term 4Intermediate Program (7 – 10) Tuesdays at 4.30pm – 6.00pmIntermediate Program (7 – 10) Wednesdays at 4.30pm – 6.00pmIntermediate Program (7 – 10) Saturdays at 9.00am – 10.30amTeenager Program (11 – 14 ) Tuesdays at 6.30pm – 8.30pmTeenager Program (11 – 14) Thursdays at 4.30pm – 6.30pmSchool Holiday Program (8 – 12) January (next available)School Holiday Program (8 – 12) July (next available) 2nd choice Select ProgramJunior Masterclass (5 – 7) Term 1Junior Masterclass (5 – 7) Term 2Junior Masterclass (5 – 7) Term 3Junior Masterclass (5 – 7) Term 4Intermediate Program (7 – 10) Tuesdays at 4.30pm – 6.00pmIntermediate Program (7 – 10) Wednesdays at 4.30pm – 6.00pmIntermediate Program (7 – 10) Saturdays at 9.00am – 10.30amTeenager Program (11 – 14 ) Tuesdays at 6.30pm – 8.30pmTeenager Program (11 – 14) Thursdays at 4.30pm – 6.30pmSchool Holiday Program (8 – 12) January (next available)School Holiday Program (8 – 12) July (next available) Emergency Contact Details All fields marked with an asterisk(*) are compulsory Name of person(s) who is/are permitted to collect your daughter* Name of Next of Kin in case of Emergency* Contact Number(s) in case of Emergency Student Health and Allergies Please indicate any food allergies or describe any restrictions due to religion Please indicate any medication that your child will be carrying with her to class: eg: Ventolin, Epipen etc Please indicate any medical conditions that may be of relevance to class activity (eg: hearing impairment, asthma, etc ) Is your child up to date with vaccinations? Please SelectYESNO Positive Attitude about Attendence I have discussed this enrolment with my child and they are committed and willing to attend. Please SelectYESNO Accept Terms I accept the Terms and Conditions. As stated As stated in the Terms and Conditions, I acknowledge that SHINE reserves the right to execuse your child from class if their behaviour (incl. punctuality and attendence) is not up to the standards espoused by our organisation. I understand the strict I understand the strict cancellation policy outlined below. 14 days minimum notice is required for cancellation of your weekly program place. 28 days minimum notice is required for cancellation of your holiday program place. Less notice will incur financial consequences (as stated in the Terms and Conditions.
