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Child’s first name
(required)
Child’s family name
(required)
Name your child is known by
(required)
Date of birth
(required)
Male / Female
(required)
Ethnicity
(required)
Child’s address
(required)
Home phone no
(required)
Parents / Guardians names (mother)
(required)
Address (mother)
(required)
Home phone no (mother)
(required)
Mobile no (mother)
Work phone no (mother)
(required)
Email (mother)
Parents / Guardians names (father)
(required)
Address (father)
(required)
Home phone no (father)
(required)
Mobile no (father)
Work phone no (father)
(required)
Email (father)
Date of Enrolment
(required)