Child First Name* Child Middle Name Child Last Name* I have completed an information form for my child OR my child has attended JAE 2017 Child 2: Child 2 First Name* Child 2 Middle Name Child 2 Last Name* I have completed an information form for my child OR my child has attended JAE 2017 Parent First Name* Parent Middle Name Parent Last Name* Parent Contact Number* Parent Email PAYMENT INFORMATION: $18/one child $30 for 2 siblings Name on Credit Card* Credit Card Number (Visa/Mastercard only)* Expiry* January February March April May June July August September October November December 2017 2018 2019 2020 2021 2022 2023 2024 CVV* Authority for my Child to Attend the Program: By signing the Authorisation, I agree to and understand the following - My child has my permission to attend . I am listed on the child's Enrolment Form as a Parent or Authorised Nominee. The contact details, including all emergency contact details, listed on my child's Enrolment Form are up-to-date. Signed: Date: E- signature and date for Child 2: Sign on the line with your mouse or fingerReset Signature This page uses 128 bit SSL encryption to keep your data secure.
