Please enter your infor­ma­tion below

SCHOOL

NUMBER OF PARTICIPANTS TO BE REGISTERED

CONTACT PERSON

First Name

Last Name

Position at school

Email

Submit

Complete for between 1 to 10 participants.

Scroll to bottom and press SUBMIT when you have entered the details for each participant.

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PARTICIPANT 1:

NAME

First Name

Last Name

Program Start Date Selected:

Northern - 31 January

Northern - 3 March

Southern - 28 January

Southern - 28 February

Dietary:

No requirements

Gluten free

Vegan

Vegetarian

Program Selected:

Northern P - 2

Northern 3 - 6

Northern 7 - 10

Southern P - 2

Southern 3 - 6

Southern 7 - 10

Other Details (for example: allergies?)

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PARTICIPANT 2:

NAME

First Name

Last Name

Program Start Date Selected:

Northern - 31 January

Northern - 3 March

Southern - 28 January

Southern - 28 February

Dietary:

No requirements

Gluten free

Vegan

Vegetarian

Program Selected:

Northern P - 2

Northern 3 - 6

Northern 7 - 10

Southern P - 2

Southern 3 - 6

Southern 7 - 10

Other Details (for example: allergies?)

---

PARTICIPANT 3:

NAME

First Name

Last Name

Program Start Date Selected:

Northern - 31 January

Northern - 3 March

Southern - 28 January

Southern - 28 February

Dietary:

No requirements

Gluten free

Vegan

Vegetarian

Program Selected:

Northern P - 2

Northern 3 - 6

Northern 7 - 10

Southern P - 2

Southern 3 - 6

Southern 7 - 10

Other Details (for example: allergies?)

---

PARTICIPANT 4:

NAME

First Name

Last Name

Program Start Date Selected:

Northern - 31 January

Northern - 3 March

Southern - 28 January

Southern - 28 February

Dietary:

No requirements

Gluten free

Vegan

Vegetarian

Program Selected:

Northern P - 2

Northern 3 - 6

Northern 7 - 10

Southern P - 2

Southern 3 - 6

Southern 7 - 10

Other Details (for example: allergies?)

---

PARTICIPANT 5:

NAME

First Name

Last Name

Program Start Date Selected:

Northern - 31 January

Northern - 3 March

Southern - 28 January

Southern - 28 February

Dietary:

No requirements

Gluten free

Vegan

Vegetarian

Program Selected:

Northern P - 2

Northern 3 - 6

Northern 7 - 10

Southern P - 2

Southern 3 - 6

Southern 7 - 10

Other Details (for example: allergies?)

---

PARTICIPANT 6:

NAME

First Name

Last Name

Program Start Date Selected:

Northern - 31 January

Northern - 3 March

Southern - 28 January

Southern - 28 February

Dietary:

No requirements

Gluten free

Vegan

Vegetarian

Program Selected:

Northern P - 2

Northern 3 - 6

Northern 7 - 10

Southern P - 2

Southern 3 - 6

Southern 7 - 10

Other Details (for example: allergies?)

---

PARTICIPANT 7:

NAME

First Name

Last Name

Program Start Date Selected:

Northern - 31 January

Northern - 3 March

Southern - 28 January

Southern - 28 February

Dietary:

No requirements

Gluten free

Vegan

Vegetarian

Program Selected:

Northern P - 2

Northern 3 - 6

Northern 7 - 10

Southern P - 2

Southern 3 - 6

Southern 7 - 10

Other Details (for example: allergies?)

---

PARTICIPANT 8:

NAME

First Name

Last Name

Program Start Date Selected:

Northern - 31 January

Northern - 3 March

Southern - 28 January

Southern - 28 February

Dietary:

No requirements

Gluten free

Vegan

Vegetarian

Program Selected:

Northern P - 2

Northern 3 - 6

Northern 7 - 10

Southern P - 2

Southern 3 - 6

Southern 7 - 10

Other Details (for example: allergies?)

---

PARTICIPANT 9:

NAME

First Name

Last Name

Program Start Date Selected:

Northern - 31 January

Northern - 3 March

Southern - 28 January

Southern - 28 February

Dietary:

No requirements

Gluten free

Vegan

Vegetarian

Program Selected:

Northern P - 2

Northern 3 - 6

Northern 7 - 10

Southern P - 2

Southern 3 - 6

Southern 7 - 10

Other Details (for example: allergies?)

---

PARTICIPANT 10:

NAME

First Name

Last Name

Program Start Date Selected:

Northern - 31 January

Northern - 3 March

Southern - 28 January

Southern - 28 February

Dietary:

No requirements

Gluten free

Vegan

Vegetarian

Program Selected:

Northern P - 2

Northern 3 - 6

Northern 7 - 10

Southern P - 2

Southern 3 - 6

Southern 7 - 10

Other Details (for example: allergies?)

SubmitBack

The cost per participant for our Structured Literacy Spaced Learning Program is $380.

Upon receipt and processing of your school's registration form, Independent Schools Tasmania will email an invoice for the total cost of the program to the School Contact Person nominated on this form.

Payment is required by the due date specified on the emailed invoice.

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I hereby acknowledge that I have read and understood the above terms and conditions.

Agree.

Name

First Name

Last Name

SubmitBack