Expression of Interest

Child’s Given Name*
Child’s Surname*
Child's Date of Birth*
MM slash DD slash YYYY
Parent/Guardian’s Full Name*
Parent/Guardian’s Address
Post Code*
Telephone Number*
Email Address*
Number of days per week to attend*
Preferred Days*
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
Date to commence*
DD slash MM slash YYYY
CAPTCHA

15 Odin Road, Innaloo WA 6018

08 9446 2476
info@climbelc.com.au

© Climb 2026