School Activity Students: Peninsula Aero Club Enrolment Form 1. Student Personal Details Given Name
Surname
Home Phone
Email Address
Mobile
2. Student Next of Kin (Parent/Guardian) Given Name
Surname
Home Phone
Mobile
Address Suburb
Post Code
Relationship to student? Do you give your permission for your student to undertake this training (if student under 18)?
YES
NO
3. Associated Costs:
30 min Trial Introductory Flight - $170.05
Flight lessons (5% Off Instructor) - $357.00
Ground Theory Lessons (5% Off Instructor) - $133.00
Junior (under 18's) PAC Club Membership - $120.00 per year (required after the first 3 lessons)
4. Payment Authorisation Parents/Guardians authorise Peninsula Aero Club to debit the following Credit Card at the conclusion of the student’s flights and ground briefings:
Mastercard
Visa
Card Number …………………………………………………. Expiry Date …………………….…. CVV……………………. Card Holders Name .…………………………………………. Parent/Guardian Signature ………………………………….
If credit card details are not provided above, payment will be required on the day of the flight/ground lesson. We will store your details in a secure manner and we will not hold your credit card details on file after completion of the activity program. The information provided on this form is covered by the provisions of the Privacy Act and Personal Information Act 1998 and will be treated as Strictly Confidential. P:\Activities\Admin and Records\Operoo\2024\Aviation Students Enrollment 2024 (002).docx