Children enrollment form

Child enrolment & permission form

* Indicates required field

Parent / Caregiver's details *

First

Last

Contact Number *

Email *

Address *

Emergency Contact *

First

Last

Contact Number *

Relationship to child *

Are you a currently EAC member? *

If you are not currently a member but would like to know more about becoming a member please click here

Child's details

Please complete below for all children in your care who are students of the EAC.

Child's Name (1) *

First

Last

Age *

Date of Birth *

Child's Name (2) *

First

Last

Age *

Date of Birth *

Classes they wish to enrol in

Class code *

Class Code *

Students name *

Price *

Payment options (Choose one) *

Direct Bank Payment (Use reference fields - class code & surname) Pay to Estuary Arts Charitable Trust 12-3046-0388526-01 Pay in person at the Centre

Payment must be received prior to commencement of class to secure enrolment. *

Total amount to pay *

Photo permission *

Yes No

From time to time we take photos during art activities. We would like your permission to use these photos on our website, in the newsletter, print advertising and/or on our Facebook page. We will never reference you/your child by name or provide any specific information regarding your child. Images will only be used for the promotion of Estuary Art Centres classes and activities.

Dependents Medical Information
Please advise us if your child has any medical conditions or special learning needs so tutor can be made aware of this. All such information will remain confidential.

Medical Condition/Special Needs *

Treatment/Stratergies *

Medical Authority

NOTE: Most of EACT staff and tutors are Certified First Aid-ers.

I give my permission to disclose this information to appropriate staff.
In event of emergency I consent to any incurred costs (i.e.: non accident ambulance).
In the event of a medical emergency, should I be unable to be contacted, I authorise the Estuary Arts Centre staff or designated parent volunteer to act in loco parentis and take whatever action they, in consultation with emergency services, deem appropriate in the circumstances.

Click here to view our General Terms and Conditions

I have read the EAC T&C's *

I agree to the above terms and conditions

I agree to receiving marketing and promotional materials

Submit