Emergency Contact Name *

Different person than above

First Name

Last Name

Please let us know about photo permissions: *

Yes, my child's picture may appear in the School Newsletter and Empire promotional material.

No, my child's face should not be present in any pictures.

Please select all relevant boxes *

I will collect my child and/or arrange collection at 5:30pm sharp

I give permission for my child to walk/ride/catch public transport home

Please select the following to confirm your understanding *

I understand that a one-time payment of $195 will be due upon my child's acceptance into Empire for the nominated term. This is NOT an automatically recurring payment. Attendance for future terms will require a new application.

*

I understand that this signup form is an expression of interest only. I acknowledge that I will receive an email or SMS within a week to confirm attendance and receive instructions on payment.

*

If Empire is already full, I understand that I will be notified and placed on the waitlist.

*

I understand that in the unlikely instance David is unable to run Empire on a day, I will be notified by email/SMS. As a working teacher it is logistically difficult for David to hold make-up sessions. These may be offered but cannot be guaranteed.