BOX HILL COMMUNITY ARTS CENTRE

Register for a Free Course

Course Name*
Course Date and Time*
Your Name*
First Last
Email*
Phone*
Address*
Street Address Suburb State Post Code
Have you or a family member attended a course at BHCAC in the past?*
- Yes
- No
Secondary Contact Name*
First Last
Secondary Contact Phone*
Name and Date of Birth of Student/s Attending*
First Name Last Name Date of Birth
Please advise of any medical conditions our staff need to be aware of:
Participation Agreement*
- I give permission for my child to attend and participate in BHCAC courses / activities. In the event of a medical emergency, I give permission for medical treatment to be administered. I have read the BHCAC Behaviour Expectations (available to download on the BHCAC website).

First Name	Last Name	Date of Birth