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Waiting List Form
The name your child is known as:
First Name:
*
Last Name:
*
Street Address:
*
Suburb:
City:
*
Post Code:
*
Date of Birth:
* (eg. 21/05/1970)
Ethnicity:
*
Gender:
Male
Female *
Parents/Guardians
Parent 1
First Name:
*
Last Name:
*
Relationship:
*
Street
*
Suburb:
City:
*
Post Code:
*
Home:
*
Work:
Email:
*
Parent 2
Ignore
First Name:
*
Last Name:
*
Relationship:
*
Street Address:
*
Suburb:
City:
*
Post Code:
*
Home:
*
Work:
Email:
*
Tribe/Hapu/Iwi your child belongs to:
Date and Times of Enrolment
Monday:
Tuesday:
Wednesday:
Thursday:
Friday:
Date the child will commence attendance at Centre:
* (eg. 21/05/1970)
