STAFFORD HEIGHTS STATE SCHOOL COMMUNITY EDUCATION

                                   Enrolment Form

After contacting phone lady please send completed form with Cheque, Money Order or Credit Card Details to:-

                Stafford Heights State School P&C

                                PO Box 1122

                                Stafford 4053

Name:- _____________________________________________________________

Address:-____________________________________________________________

 ____________________________________________________________________

 Phone:- ______________________ (Home)____________________________(Work)

                          ___________________________________(Mobile)

Email Address:-________________________________________________________

Course:-______________________________________________________________

Day:-__________________________Time:-_________________________________

                    For Credit Card Holders Only:-

Credit Card Number:-___________    __________   __________   __________

 Card Expiry Date:-_______  /  _______        Mastercard ____ Visa____

 Name Printed on Card:-___________________________________________________

 I hereby authorise the Stafford Heights State School P&C- Community Education to debit my credit

 card account, the amount of $.....................  Signature:-...............................................

IMPORTANT:-Your enrolment is not final until form and full fees have been received.

You will be advised if a class you have booked into is cancelled.

Receipts will usually be issued at the second class - no further advices will be forwarded.