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 CollegeMinaretCranbourne Secondary CollegeCranbourne East Secondary CollegeTimbarra P-9St Peters College CranbourneFountain Gate Secondary SchoolOfficer CollegeGleneagles Secondary SchoolRivercrest Christian CollegeHeritage CollegeHallam Senior Secondary CollegeGlen Waverley Secondary CollegeMaranatha CollegeGlenvale SchoolMelbourne High SchoolMac Robertson Girls SchoolSirius CollegeHillcrest Christian CollegeLighthouse Christian College Other (Please write "Further Details" in the comments)

What year level are you in 2021? *

• 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?

I have contacted Andrew and I would like to join the following class... *

Phone

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