Enrolment Student Name * First Name Last Name Student's Current School Year * PreK Kindergarten Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Enrolment Status * New Student Currently Enrolled (in one or more classes at 123 Education) Parent/Guardian Email Parent/Guardian Phone Number * Medical Details/Allergies * Please include any allergies or medical conditions your child may have so our staff can take all necessary precautions for the safety of your child. Do you have another child enrolled with us? Please include student's name Terms & Conditions * By checking this box, I have read and agreed to 123 Education's Enrolment Terms & Conditions (refer to Terms & Conditions page) Thank you!