Student Roster Form

Name *

First

Last

Date of Birth

Email *

Mobile Phone

WWC Card Number

If over 18, you require a valid working with children check

WWC Expiry Date

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

If you are Under 18, you require your parent's signature to work on roster

First

Last

Parent name

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