Parent Name

Parent Email

Parent Phone Number

Student Name

Student Email

Student's Phone Number

Student School

Current Year Current Year Year 11 Year 12

Preferred Campus Preferred Campus Chatswood Dee Why Virtual

Requested Trial Day (Face to Face) Requested Trial Day (Face to Face) Monday Tuesday Wednesday

Requested Trial Day (Virtual) Requested Trial Day (Virtual) Friday 4:00 pm - 7: 00 pm Sunday 10:00 am - 1:00 pm

Student's Subjects

Does your child have any medical conditions we should be aware of? Does your child have any medical conditions we should be aware of? Yes No

If Yes, please provide details