Centre Location: * —Please choose an option—Unit 11, 7 Hoyle Avenue, Castle Hill NSW 215484 Cecil Avenue, Castle Hill NSW 2154

Child’s Name: *

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Child’s DOB：*

Child’s Sex MaleFemale

Child’s Day School Name: *

Child’s Grade Attended at Day Shool: * —Please choose an option—KindyYear 1Year 2Year 3Year 4Year 5Year 6

Parent Name: *

Parent Mobile No.: *

Email *

Emergency Contact Name 1 : *

Emergency Contact Number 1 : *

Emergency Contact 1 Relation To child: *

Emergency Contact Name 2 : *

Emergency Contact Number 2 : *

Emergency Contact 2 Relation To child: *

I give permission for teachers to use the photograph/video of my children within Shine Learning Centre and to promote the class? YesNo

Does your child suffer from any medical condition/food allergies? YesNo

If answer above is yes, Please give the details:

Consent: I agree to accept responsibility for costs incurred on my behalf in securing medical treatment and associated services for the above mentioned child requiring medical treatment or in the case of a medical emergency.I also consent to the Shine Learning Centre to provide first aid.I understand that Shine Learning Centre does not provide automatic personal injury or liability insurance for student accidents which are inflicted by the students themselves.

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