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* 1. Please advise which Dingoes program/s you would like to enrol your child in:
Dingoes 8 - 15 years - Tues
Dingoes 8 - 15 years - Thurs *waitlist

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* 2. Please share a little more about your family's interest in joining our homeschool co-op

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* 3. Details of Child: Full name, date of birth, gender

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* 4. Details of Parent / Guardian 1: Full name, address, phone, email, place of employment

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* 5. Details of Parent / Guardian 2: Full name, address, phone, email, place of employment

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* 6. Custody Arrangement (If Applicable)

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* 7. Child Development / Disability / Learning Difficulty / Medical Conditions: Please describe below if your child has any special needs that may effect their participation in our programs or groups.

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* 8. Please share a little about your child's / childrens Temperament

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* 9. Please note that our Dingoes programs require each family to contribute at least one session of caregiver help on a rotating basis per term per program that your child attends, to support our Facilitators each session.

Caregiver help can be contributed by a primary caregiver, grandparent or another adult family member or friend. If you are unable to find someone to do your families caregiver help contribution, you may also choose to pay one of our relief caregiver helpers to cover your family (the current suggested rate of pay for relief caregiver help is $30 per hour).

All caregiver helpers are required to have a working with childrens check and you will need to add this to your childs registration.

Do you agree to fulfill your caregiver help contribution per term?

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* 10. We acknowledge that we have read all of the information provided on the Village Learning website, including the Current Programs & Term Fees and the Village Learning Values & Agreements.

We have provided all relevant information for our child in this Application Form and we understand that failure to disclose any information that may impact upon our child’s experience and participation in the Village Learning Programs could result in cancellation of the child's place.

We understand that fees are paid for the term in advance and are not subject to adjustment because of illness or absence, or refundable in the instance of withdrawal from Village Learning.

PLEASE SIGN YOUR FULL NAME/S BELOW:

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* 11. I the parent or caregiver understand that Village Learning is an organisational body, coordinating independent educators & facilitators to offer the Margaret River Region homeschool community a range of educational programs & classes. Each of these independent facilitators are responsible for their own Insurance & for providing responsible care of the children during any Drop & Leave programs.

PLEASE SIGN YOUR FULL NAME/S BELOW

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* 12. Best time for a follow up phone call

T