Childs First Name (required)

Childs Surname (required)

Childs DOB (required)

Childs Gender (required)

Address

Email (required)

Parent First Name (required)

Parent Surname (required)

Parents Email (required)

Details of Person Enrolling the child First Name (required)

Details of Person Enrolling the child Surname (required)

Details of Person Enrolling the child Email (required)

WIZO Group (required)

Details of Person Enrolling the child Phone (required)

Names to be used in greeting

ABN: 50 756 635 036

Beth Weizmann
1st Floor, 306 Hawthorn Road
Caulfield South, Victoria 3162
Australia

Tel: (03) 9272 5588
Fax: (03) 9272 5590
E-mail: wizo@wizovic.org