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KOTB STUDENT ENROLMENT
Please list the class or classes you are enrolling into:
Date of Birth
School Student Attends
Student Mobile Phone Number
Student Email Address
Student Residential Address
Address Line 2
ZIP / Postal Code
Medical Conditions (if none please type N/A)
I give permission for my child to be administered Panadol.
I give permission for photographs to be taken of my child.
I give permission for video footage to be taken of my child.
I give permission for photos and videos of my child to be used for KOTB media and marketing purposes.
In the event of an injury/accident, I give authorization for staff to obtain medical assistance if necessary until I/we can be contacted and subsequently accept any medical expenses incurred.
Relationship To Child
Optional Extra Information
How Did You Hear About KOTB Performance Academy?
If you selected other in the above question please tell us more detail.
Have you "Liked" the KOTB Performance Academy Facebook page yet?
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I/We consent for our child/children to participate in KOTB classes and agree to pay all applicable fees by the due date.
All information provided is accurate at the time of submission.
This field is for validation purposes and should be left unchanged.