Diving Enrolment Form - MLC School
Diving Enrolment Form - MLC School
Diving Enrolment Form - MLC School
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<strong>Diving</strong> <strong>Enrolment</strong> <strong>Form</strong><br />
Term 4 2013<br />
Student Name:<br />
<strong>School</strong> Year:<br />
______________________<br />
______________________<br />
Date of Birth: / /<br />
Please fill in all fields<br />
<strong>MLC</strong> <strong>School</strong> Student: Yes No Future student (tick one)<br />
<strong>MLC</strong> Junior <strong>School</strong> Pick up required: Yes No (tick one)<br />
Available for Kindergarten to Year 5 <strong>MLC</strong> <strong>School</strong> students only – Thursday afternoon<br />
<strong>Enrolment</strong> Type: New student Continuing student (tick one)<br />
Parent/Guardian Name:<br />
Home Address:<br />
______________________<br />
___________________________________________________-<br />
___________________________________________________________________<br />
Phone: (H) ______________________ (M) __________________________<br />
Email: _____________________________________________________________<br />
Emergency Contact – Complete if NEW student, or details have changed<br />
To be contacted if parent/guardian unreachable in the event of an emergency<br />
Name: _____________________<br />
Phone: (H) ______________________ (M) __________________________<br />
Relationship: ______________________<br />
Medical Information – Complete if NEW student, or details have changed<br />
Student Medicare No: ______________________<br />
Does your child have a diagnosed medical condition that may require first aid?<br />
Yes No<br />
If yes, please circle relevant condition and provide details:<br />
Allergies Asthma Heart Diabetes Joint<br />
Condition<br />
Condition<br />
Seizures<br />
Other<br />
Details:
Session Selection<br />
Term 4 2013 – Tuesday 8 October 2013 – Saturday 21 December 2013<br />
Please Tick Sessions<br />
Sessions<br />
Morning<br />
Afternoon<br />
Weekend<br />
Tuesday<br />
6.45am – 7.45am<br />
<strong>MLC</strong> <strong>School</strong><br />
*$150 per term<br />
Wednesday<br />
6.45am – 7.45am<br />
<strong>MLC</strong> <strong>School</strong><br />
*$150 per term<br />
Thursday<br />
3.25pm – 4.25pm<br />
<strong>MLC</strong> <strong>School</strong><br />
*$150 per term<br />
Cost<br />
Thursday<br />
6.45am – 8.15am<br />
<strong>MLC</strong> <strong>School</strong><br />
*$200 per term<br />
Thursday<br />
6.30pm – 8pm<br />
**Various venues<br />
*$200 per term<br />
Saturday<br />
10am – 12pm<br />
*$250 per term<br />
Total Cost $<br />
* Fees per term may vary slightly depending on number of weeks of term and<br />
public holidays.<br />
** See attached sheet for venue information.<br />
*** Training sessions at SOPAC are subject to extra training fees
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