Person submitting registration.
Class option (please tick): ICAN Act ICAN Dance ICAN Sing ICAN Kapahaka
Students Details:
Sex:male female
School / organisation details
Independent Student Supported Student
Billing information (please tick who is to receive the billing information)
Student Primary Caregiver School / organisation
Class subsidy
Student has a physical / intellectual disability and would like a 50% class subsidy generously provided by Idea Services Waitaki
YES NO
+ + + + + + + + + + +
term and conditions.