Student Information

First Name *

Last Name *

Date of Birth *

When calendar is opened, please click on year or month to open the drop down, and select your birth year/month.

Gender *

male

female

Mobile Number *

WhatsApp Number *

Email *

Address

Street Address *

City *

State *

Country *

Postal code *

Class Timings:

Males

Monday to Thursday, 7:30 PM - 9:30 PM Melbourne Time.

Females

Option 1, Morning Session

Monday to Thursday, 10:00 AM - 12:00 PM Melbourne Time.

Option 2, Evening Session

Monday to Thursday, 7:30 PM - 9:30 PM Melbourne Time.

Which class you are going to enroll? *

Morning

Evening

Do you suffer from any type of disability, impairment or medical condition that may affect studies? If yes, please provide details. *

Yes

Please provide details of disability, impairment or medical condition

Do you require any special provisions to be provided by the institute? If yes, please provide details. *

Yes

Details of special provisions needed

Photo ID e.g. Driving License, Passport etc. *

Emergency Contact Details

Emergency Contact Person *

Emergency Contact Number *

Parent Guardian 1 Name *

Parent Guardian 1 Phone Number *

Parent Guardian 2 Name

Parent Guardian 2 Phone Number

Disclaimer

Declaration

I have read and agree to the terms & conditions provided by the institute.