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Student Details

Student Full Name

First

Last

Student Birthday

Registration Status

Email

Confirm Email

Phone

Home Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Student Age as at 31st August

Class Details

Classes Attending

Monday (Bardon)
Tuesday (Deebing Heights)
Thursday (Paddington)
Friday (Lutwyche)

(You can select multiple days).

Age Group

Ladies & Seniors Only – Which Age Group Are You?

Emergency Contact Details

Emergency Contact Name

First

Last

Emergency Contact Phone Number

Emergency Contact Email

Registration Payment Options

Payment Option

Extension Program Registration

Extension Program Registration Fee

Price: $89.00

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Extension Program Payment Option

Pay per Term ($149)
Annual (20% Discount) ($475)

Coupon

Total

$0.00

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I acknlowedge that all Annual Registrations are for the full year, and cannot be cancelled. If you wish to register on a term-by-term basis, please select that option.

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I acknowledge that term by term regsitrations will automatically renew unless cancelled via email prior to the first day of classes for the next term.

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I accept that no registration or term fees are refundable under any circumnstances

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I acknowledge that I will have to pay a BjP Registration fee ($99) directly to BjP Head Office

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I consent to photography being used on our website, social media and any other marketing material

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Please discuss with us if there are any other issues with this.

I have read and accept all terms and conditions at https://www.cityphysie.com.au/terms-and-conditions/

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Student Details

Class Details

Emergency Contact Details

Registration Payment Options

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