@Home Academy Registration Form

First Name:

Last Name:

Parent/Caregiver 1:

Parent/Caregiver 2:

Address:

Suburb:

City/Region:

Post Code:

Phone:

Email:

Date of Birth:
-- Select Day -- 12345678910111213141516171819202122232425262728293031 -- Select Month -- January February March April May June July August September October November December -- Select Year -- 201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945

Gender:
-- Select an option -- Female Male

Approximate School Year Level: -- Select an option -- Year 6 Year 7 Year 8 Year 9 Year 10 Year 11 (NCEA Level 1) Year 12 (NCEA Level 2) Year 13 (NCEA Level 3)

How did you find out about Spin Radius Online Academy?:
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