West Auckland Parents Centre
Parent Education Enrolment Form
Course Code
*
Please check the course code is correct (refer to website)
Name
*
First
Last
Partner/Support Person Name (if attending)
First
Last
Contact Number
*
Email
*
Ages of Children
*
Seperate ages by comma. eg 1,3,5
Current member of West Auckland Parents Centre
*
Yes
No
How did you hear about West Auckland Parents Centre
*
LMC
Posters/Flyers
Word of Mouth
Internet
Other
Maximum Allowed:
250
characters.
Currently Used:
0
characters.
How would you like to pay?
*
Bank Transfer
Credit Card (incurs additional processing fee, ~3%)
Privacy
The information collected on this form will only be used for the purposes of course evaluation, membership records or in the collection of PCNZ statistics, in which you will not be identified
Do Not Fill This Out