Enrolment Form

This form must be completed by a parent or guardian who has lawful authority in relation to the child.

CHILD’S DETAILS

Given Name *

Surname *

Date of Birth *

Address *

Suburb *

Medical Conditions *

N/AAllergyOther

Please Specify

Choose from the following program *

School Readiness 4-6 Years Old 1:1 Intervention 4-14 Years Old 60 Minutes Group Sessions 6-14 Years Old NDIS Therapy Sessions

NDIS Funded *

YesNo

Parent/Guardian 1

Full Name *

Home Address *

Phone *

Relationship to Child *

Occupation

Email Address *

PARENTAL AGREEMENT

I give permission for

Learning Without Limits staff to administer all necessary First Aid Treatment to my child *

YesNo

Learning Without Limits Staff to seek qualified medical treatment at a hospital or call a doctor and/or ambulance and agree to pay the relevant costs incurred. *

YesNo

I agree that I will notify the centre of an absence and follow the 48 hour cancellation policy
*

Signature *

Clear

I agree to the terms and conditions.

https://learningwithoutlimits.com.au/terms-conditions

*

Enrolment is subject to availability