Student and Emergency Contact Details

Student Full Name *

First

Last

Address *

Address

Suburb *

Student's Mobile Number (Reminder texts will be sent to this number) *

Student's Email (If you are already using Microsoft Teams, give Teams email please) *

Email

Confirm Email

Please enter your email, so we can follow up with you.

Emergency Contact (Parent Details) *

First

Last

Emergency Contact Number (Parent Mobile) *

Known Allergies

Are you anaphylactic? Do you carry an epipen?

Current School AttendedNossal High SchoolMazenodSt Margarets and Berwick GrammarHaileybury - Berwick CampusHaileybury - Keysborough CampusBeaconhills CollegeSt Francis Xavier (Middle)St Francis Xavier (Senior)Berwick Secondary SchoolKambrya CollegeAlkira CollegeMinaretCasey Grammar SchoolCranbourne Secondary CollegeCranbourne East Secondary CollegeTimbarra P-9St Peters College CranbourneFountain Gate Secondary SchoolOfficer Secondary CollegeGleneagles Secondary SchoolRivercrest Christian CollegeHeritage CollegeHallam Senior Secondary CollegeGlen Waverley Secondary CollegeMaranatha CollegeMelbourne High SchoolMac Robertson Girls SchoolSirius CollegeHillcrest Christian CollegeLighthouse Christian College Other (Please write "Further Details" in the comments)

What year level are you in 2022? *

• Year 9
• Year 10
• Year 11
• Year 12

How did you hear about us? Did someone recommend you (please give their name)? Or was it google/facebook/instagram etc?

Please select the class you wish to enrol in: *

• Unit 3&4 Chemistry - Sunday 2:00-4:00pm Cost: $50 Teacher: Hasna
• Unit 1&2 Chemistry - Sunday 4:15-6:15pm Cost: $50 Teacher: Pinak
• Year 10 Chemistry - Sunday 6:30-8:30pm Cost: $40 Teacher: Pinak

Comments:

Discounts for multiple classes (Speak to Andrew to find out these)

If you are not enrolled in multiple classes, you can receive a 10% discount by paying for 10 classes up front.

No further discounts apply.

Name

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