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by PSC_Amin | Jan 29, 2019

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Kids Class Enrolment Form

Student Record
STUDENT RECORD 20...
Student's Information
Student's Information*
First Last
Date of Birth*
Date Format: MM slash DD slash YYYY
Grade/Year*
Australian Citizen
Australian Citizen
- Yes
- No
Permanent Resident
Permanent Resident
- Yes
- No
Parent's Information
Parent’s (Guardian’s name)*
Telephone numbers:
Home*
Work
Mobile*
Email Address
Parent’s e-mail address*
Address
Address*
Street Address City ZIP / Postal Code
Emergency Contact if different from above
Emergency Contact if different from above*
Any specific medical factors affecting the child
Any specific medical factors affecting the child*
The name of the family doctor
The name of the family doctor
Phone number of the family doctor
Phone number of the family doctor
Permission to call ambulance in case of emergency
Permission to call ambulance in case of emergency*
Prices Per Term

Please choose below in which ordinal number the child was enrolled in Polish School Canberra.
Prices*
Please input HOW MANY TERMS (NOT PRICE) in the quantity field.
1st Child
1st Child
Price: $ 100.00 Terms:
2nd Child
2nd Child
Price: $ 90.00 Terms:
3rd Child
3rd Child
Price: $ 0.00 Terms:
4th Child
4th Child
Price: $ 0.00 Terms:
Total Amount
Total Amount
$ 0.00
Payment Options
Payment Options*
- Cash (at school)
- Bank Transfer
- Credit or Debit Card
Simply come to the school, complete an enrolment form, together with the cash, and we can process your enrolment.
Here are our bank account details:

Bank: St George Bank
Account Name: The Polish Educational Committee
BSB: 112 908
Account Number: 153 397 125
If paying electronically please state "surname" and "term x" as a reference.
Credit Card*
American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Date
Date*
Date Format: DD slash MM slash YYYY
Name
This field is for validation purposes and should be left unchanged.

Adult Class Enrolment Form

Student Record:
Student Record
Student's Information:
Student's Information*
First Last
Telephone numbers:
Home*
Work
Mobile*
E-mail address:
E-mail address*
Address:
Address
Street Address City ZIP / Postal Code
Emergency Contact (Optional):
Emergency Contact (Optional)
Name
Phone Number
Email Address
Adults Per Term Payment
Please input HOW MANY TERMS (NOT PRICE) in the quantity field.
Adults Per Term*
Price: $ 150.00 Terms:
Total Amount
Total
$ 0.00
Payment Options
Payment Options*
- Cash (at school)
- Bank Transfer
- Credit or Debit Card
Simply come to the school, complete an enrolment form, together with the cash, and we can process your enrolment.
Here are our bank account details:

Bank: St George Bank
Account Name: The Polish Educational Committee
BSB: 112 908
Account Number: 153 397 125
If paying electronically please state "surname" and "term x" as a reference.
Credit Card*
American Express
Discover
MasterCard
Visa
Card Number Exp. Date Sec. Code Cardholder Name
Date:
Date*
Date Format: DD slash MM slash YYYY
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