Programme Package Registration Form

Customised Lessons

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Parent/Guardian Name *

First

Last

Parent/Guardian Email *

Parent/Guardian Phone *

Do you receive text at this number?

What Permission grade

Person authorized to pickup the child

Child's name *

First

Last

Child's date of birth *

Child's Gender

Female
Male

Child's Age

Health Concerns

Ex. Allergies - Please state food / conditions that the child is allergic to

Please select your preferred session

Please select your preferred session duration *

4x a week/ month - $3,000.00
3x a week / month - $2,400.00
2x a week / month - $1,600.00
Once a week / month - $900.00
One on one / month - $1,000.00

Please select your preferred schedule

Total

$0.00

What grade level is the Child in?

If between grades, list the grade the child will be in at the start of the next school year.

Preferred Start Date

Number of previous years that he/she attended school

Put N/A if not applicable

Educational Background

Highest level of education and year of graduation. Put N/A if not applicable

School's name other than Young Caterpillars Creative Learning Playhouse

Put N/A if not applicable

Permission & Agreement *

I agree and give my permission
I do not agree
Only for my personal update/emails etc.

We occasionally take pictures of the kids in action with the materials or doing other activities for our FB Page and promotional materials. We
hope to use these to keep parents up to date on the happenings at school and to help promote our classes.

Terms and conditions

I agree to the terms and conditions of the course and the school's policies.

School fee is paid monthly and in advance or on the first day of attendance.
Mode of Payment: by Cash, FPS or through HSBC
Account name: Marsden Catherine Tating
Account number: 828 413211 833
Please submit completed form and payment before the first attendance to complete the registration process.
Payment is non-refundable.

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