* Denotes a mandatory field. Should you miss a mandatory field this form will not send.
* Student is enrolling at (please tick one):
* Program: 2 day program (Cost: $250 per term) 1 day program (Cost: $150 per term) All one day programs run on a Monday. Under special circumstances UJEB may be able to accommodate variations to the above rules. These variations will only be possible if there is a significant demand.
* Program: Tuesday (Cost: $150 per term) Thursday (Cost: $150 per term) both (Cost: $250 per term)
Cost: $220 per term
Cost: $175 per term
I agree to the above Conditions of Enrolment for Caulfield South
Name: Day School: Year Level: Date Of Birth:
Name: Email: Mobile: Home Phone: Address: Suburb: Postcode:
Name: Email: Mobile:
Same as above? Home Phone: Address: Suburb: Postcode:
Please advise of any relevant medical information including but not limited to medical conditions (such as asthma, diabetes etc), medication taken, any allergies suffered (including food, medication, bee stings etc) or any other information (including dietary requirements) that should be brought top UJEB’s attention:
Name: Relationship to Child: Mobile: Home Phone: Other Number:
Who is responsible for the fees? Mother Father Other (please fill in) Name: Email: Mobile: Home Phone: Address: Suburb: Postcode: * Please indicate how you would like to pay: Cheque Please make all cheques payable to United Jewish Education Board Direct Bank Transfer Account name - United Jewish Education Board Inc Bank - ANZ Bank BSB - 013006 Account number - 8686924 Please remit receipts to accounts@ujeb.org.au Credit Card Credit card will be available online shortly. In the mean time, please call the UJEB office on 92725522 to pay with a credit card.
I agree to the above Conditions of Enrolment
* I wish to be contacted on this email address: