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Parent / Guardian Contact Details

• First name*
• Last name*
• Email address **
• Address Line 1 **
• Address Line 2
• Suburb*
• State*
  VictoriaNew South WalesSouth AustraliaWestern AustraliaQueenslandNorthern TerritoryTasmania
• Postcode*
• Contact number **
• Relationship to student*

• Student Details

• First name **
• Last name **
• Date of birth DD/MM/YYYY **
• Please select the applicable campus*
  Sandringham Prep-Year 6Sandringham Early Learning/Long Day CareBrighton Jnr Prep-Year 6Brighton Early Learning/Long Day CareBrighton Year 7 - 12
• Proposed year level of entry to Firbank*
• Proposed Year of entry to Firbank*
• Current School*