HSC CoWorks - Trial Enrolment

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* 1. HSC year

HSC 2020

HSC 2021

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* 2. Parent 1 Details

First Name / Last Name *

Address *

Address 2

Suburb *

Postcode *

Email Address *

Phone Number *

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* 3. Student Details

First Name / Last Name

Email Address

Phone Number

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* 4. Student's Date of Birth

D.O.B

Date

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* 5. Student's School

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* 6. Student's Subjects

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* 7. Do you now, or have you ever had, another child on the HSC CoWorks Programme? Note name below.

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* 8. Preferred Trial Session (Weekday)

DEE WHY: Tuesday 4-6pm

DEE WHY: Tuesday 6:15-8:15pm

DEE WHY: Wednesday 4-6pm

BONDI JUNCTION: Monday 4-6pm

BONDI JUNCTION: Tuesday 4-6pm

BONDI JUNCTION: Wednesday 4-6pm

MOSMAN: Tuesday 4-6pm

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* 9. Does your child have any specific learning difficulties that you think we should be aware of?

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* 10. Does your child have any medical conditions we need to be aware of?

If yes, please describe the condition and attach a Medical Action Plan (in Q15) as prescribed by the doctor (if applicable). Please note that for health and safety reasons, HSC CoWorks reserves its rights to decline your child’s enrolment if we are of the view that our staff members are unable to administer your child’s Medical Action Plan.

Yes

No

Comments

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* 11. Please attach Medical Action Plan

If required as per Q14

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.