Booking Request - New Students

Name *

First Name

Last Name

Preferred method of communication (please select)

Email

Text Message

Phone Call

Emergency Contact *

First Name

Last Name

Keep up to date

I wish to receive seasonal emails and updates from The Centre of Bright Beginnings as well as a free welcome resource

Are you currently experiencing marginalisation or financial hardship?

Please check this box if you would like us to offer you a subsidised rate and we will be in touch.

Electronic Signature of Student, Parent or Gaurdian *

By checking this box, I hereby electronically sign that I have read, understood and agree to The Centre of Bright Beginnings Informed Consent Policy.

Name *

First Name

Last Name

Electronic Signature of Student, Parent or Guardian

By checking this box, I consent to photographs, recorded images of myself and any other participants I am responsible for and any written communications/testimonials being used by the Centre of Bright Beginnings for activities including promotion and programming. I consent to the use and disclosure of any such media without payment to me.

Name

First Name

Last Name