Student First Names

Student Last Name

Student Date Of Birth

Email Address

Phone

I confirm I have read and agree with the term conditions privacy policy (or parent/guardian on students behalf). I confirm I have read and agree with the term conditions privacy policy (or parent/guardian on students behalf). Confirmed

I have read, agree & meet the requirements of the physical readiness & consent waiver (or parent/guardian on students behalf). I have read, agree & meet the requirements of the physical readiness & consent waiver (or parent/guardian on students behalf). Confirmed

Name of Payer (student name if same)