Enrollment Application - Mini Explorers

061 440 7079 | info@miniexplorers.co.za

📍 Bloemfontein • Open Mon-Fri 7:00 AM - 5:00 PM

Enrollment Application

Complete this form to begin your enrollment process at Mini Explorers

Child Information

Child's First Name

Child's Last Name

Child's Date of Birth

Child's Gender

Parent/Guardian Information

Parent's First Name

Parent's Last Name

Parent's Email

Parent's Phone

Address

Address Line 1

Address Line 2

City

Province/State

Postal Code

Emergency Contact

Emergency Contact Name

Emergency Contact Phone

Relationship to Child

Program Selection

Program

Preferred Start Date