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Application Form
Kids With Courage 2025
Parents Information Evening is Friday 25 July at 7.30 pm
Course runs for 7 weeks starting Friday 1st July and finishes Friday 12 September.
Begins at 5.15 pm with a light meal
Parents name
First name
Last name
Address
Address line 1
Address line 2
Address line 3
Address line 4
Town/Suburb
City
Postcode/Zip
Home phone
Cell phone
Email address
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Child's name (s)
Please complete separate form for each child in the family
First name
Last name
School
School Year
Date of Birth
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In your opinion, what are your child's main interests?
What are your child's main strengths?
What major concerns do you have about your child?
In your opinion, what ideas could be implemented to improve or overcome this?
Do you have any other relevant information you think is important for us to know?
Has your child received any individual counselling?
Yes
No
Please list any food allergies?
Is your child on any medication?
Yes
No
If yes, please provide details
Other Comments
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How did you hear about this course
Cost
$50.00
Pay method
Internet Banking
Make deposit to account
03 0887 0281519 00
Cash
Cash payment
EFTPOS
EFTPOS Available onsite
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Please check the highlighted fields
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