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DD/MM/YYYY
If "Yes", please enter additional students' information below.
DD/MM/YYYY
DD/MM/YYYY
For students under 18 years of age.
(e.g., home, cell, work)
For students under 18 years of age.
(e.g., home, cell, work)
Please select the desired form of instruction:
8 weekly sessions; $200 / child AND parent
Is there any additional information we should know about the student (e.g., allergies, etc)?
Provide the names of any other individuals other than the listed Parent(s) / Guardian(s) who are authorized to pick the student up from Sesaya.

By clicking Submit, you have read, and agree to, our Terms and Waiver.