Cheeky Monkey Club Cairns & Brisbane | Interaction and Imagination for children

student

Student name*

Age*

Mother

Father

Date of birth*

Postal address*

Post Code*

Email*

Phone Home

Phone Work

Mobile

Other/Comments

Payment Option

City Classes

City Classes

Venue Address: 148 Mulgrave Rd, Pelicans Child Care Centre

Wednesday Tick Selected Class

9.15 - 9.45am Kindy Kids 2½ - 3½yrs

10.00 – 10.45am Pre Schlers 3½ - 5yrs

Saturday Tick Selected Class

9.00 - 9.30am Kindy Kids 2½ - 3½yrs

9.45 - 10.30am Pre Schlers 3½ - 5yrs

10.45 - 11.30am 5-6yrs Juniors

11.45 – 12.30pm 6-8 yrs RX Level 1

12.30 - 1.15pm 8-12 yrs RX Level 2

Kewarra Beach

Kewarra Beach

Venue Address: Poolwood Rd, Kewarra Beach Community Hall

Wednesday Tick Selected Class

4.00 - 4.45pm 6 - 8 yrs RX Level 1

4.45 - 5.30pm 9 - 11yrs RX Level 2

5.30 - 6.15pm 12yrs & up RX Level 3

Friday Tick Selected Class

9.15 - 9.45am Kindy Kids 2½ - 3½yrs

10.00 - 10.45am Pre Schlers 3½ - 5yrs

Privacy

I give permission for photos &/or videos to be taken of my child for use in media, advertising, documents and scrapbooks:

Please Tick*

Yes

Name on Credit Card

Credit Card Number

Expiry Date

CCV:

Payment Type

Amount

Starting Date

New Students: A $25 Membership fee is applicable to all NEW CMClub Students when submitting this completed enrolment form (not applicable to existing students).Enrolments are only confirmed once we have received both.

Payment Options: Credit Card, Cash, Cheque, Branch Deposit or Electronic Transfer.

Bank Details - Suncorp BSB: 484 799 A/C Name: Cheeky Monkey Club A/C #: 1617 31998

Reference Code: K for ‘Kewarra’ C for ‘City’+ Class Level +Dancer’s surname
EG. Amy Hall enrolled in a City Kindy Class - Reference as: CKindyHall IMPORTANT- please then forward a confirmation email

Submit

Cheeky Monkey Club Enrolment Form