Play at the Con - Enquiry Form

Play at the Con – Enquiry Form

Please submit an application if you would like to commence lessons in Term 3 2017.

Please complete this form if you would like to arrange lessons with a teacher through the Play at the Con programs:

Student's First name ^*

Student's Family name ^*

Date of birth ^*

E-mail ^*

Phone number ^*

If the student is under 18 years of age please provide the following additional information:

Parent/Guardian's First Name

Parent/Guardian's Last Name

Parent/Guardian's E-mail

Parent/Guardian's Phone number

Name of school student is enrolled at

School year e.g. Year 5

Preferred teacher's name ^*

Area of tuition ^*

Preferred lesson duration ^*

Previous training ^*

Preferred day - 1st choice ^*

Preferred day - 2nd choice ^*

Please note specific lesson times are to be agreed with the teacher.

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