Advanced 3-6 Observation Program – Registration Form

Advanced 3-6 Observation Program Registration Form

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Phone

This field is for validation purposes and should be left unchanged.

Personal Details

Which Advanced Observation course are you registering for?*

2026 with Amy Kirkham

Personal Details

Name*

First Last

* Please use the name you would like to see on your certificate.

Prefer to be called by

Email address*

Mobile Phone Number*

If you live outside of Australia please include the country code first

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Mobile number

Date of birth*

Country of birth*

Country of Nationality*

Please list all that apply.

Gender*

Female

Male

Other

Prefer not to say

Residential Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is your postal address different to your residential address?*

Yes

Postal Address (if different from residential address)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Emergency contact details

Emergency Contact*

Emergency Contact First Name Emergency Contact Last Name

Relationship*

Emergency Contact Mobile Phone Number*

If you live outside of Australia please include the country code first

This field is hidden when viewing the form

Emergency contact's mobile

Working with Children Check

For Australian residents only.

Working with Children Check Number:

WWCC Expiry Date:

Language and Cultural Diversity

Please select which applies.

Residency status*

Australia Citizen

Permanent Resident in Australia

Neither

Is English your second language?*

No, English is my first language

Yes, English is my second language

Please specify your first language

If more than one language, select the language most spoken.

Are you of Aboriginal or Torres Strait origin?*

Yes, Aboriginal

Yes, Torres Strait

Yes, Both Aboriginal and Torres Strait

Individual Learning Needs

Do you consider yourself as having a disability, impairment or long-term medical condition that might affect your participation in this qualification?*

Yes

Prefer not to say

All personal information will be handled confidentially. The questions in this section are only asked for the purposes of SMTC being able to offer support and arrange reasonable adjustments to support the student’s course participation. This is an invitation for disclosure, not a requirement. Students with disability, impairment or condition do not have to disclose their circumstances unless they would like to arrange adjustments or their disability, impairment or condition poses a risk to themselves or others.

Please specify:*

If you selected Yes above, please indicate the nature of your individual learning needs/s.

Cognitive

Physical

Please specify:

Are there adjustments you believe we may need to make in order for you to be successful in participating in the program?*

Yes

Please specify:

Education

Have you successfully completed any of the following qualifications listed?*

3-6 Montessori Diploma

Montessori Diploma covering the early years including 3-6

Montessori Bachelor Degree covering 3-6

Other Montessori 3-6 Diploma equivalent

Select all that applies.

Please specify details of your 3-6 qualification including (a) name of qualification (b) year of attainment and (c) training centre or education institution. If applicable (d) please include your qualification number.*

Employment

What best describes your employment situation?*

Employed: Full-time/ part-time/casual

Self-employed – not employing others

Employed – unpaid in family business

Unemployed – seeking full-time employment

Unemployed – seeking part-time employment

Not employed – not seeking work

What is your role with your organisation (if applicable):

Name of Employer (if applicable):

Reason for study

How did you hear about this course?*

Word of mouth

SMTC website

Promotion from another Montessori organisation

Google or internet search engine

Social media

Other

Please specify:

Fees and payment details

Payment options:*

I will be paying my own fees

My school/centre/employer/other will be paying my fees

How would you like to pay?*

I would like to receive an invoice to pay via electronic funds transfer (EFT).

I will make payment online via credit card.

An online payment link is available after submitting the application form.

Would you like to pay in instalments?*

No – I will pay upfront in a single payment

Yes, a $200 deposit and then $160 in terms 2,3,4 (plus any applicable GST)

Yes, a $200 deposit & $20 a week (plus any applicable GST)

Yes, a $200 deposit and then I would like to speak to SMTC about customising a payment plan for the remainder

Organisation name:

Organisation Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Contact name for invoices

First Last

Email contact for invoices

Organisation Phone

PHOTOGRAPHY CONSENT

YES I authorise Sydney Montessori Training Centre to take and use any photographs and/or media including me or reference to me on its website or any other digital platform.

NO I do not give permission for photographs to be taken and/or used by Sydney Montessori Training Centre on its website or any other digital platform.

SMTC values the opportunity to share the fantastic work that happens at our Training Centre via various media platforms. This enables our Montessori community to keep abreast of our news and also helps us to spread the positive word of Montessori to the wider community. It also enables us to encourage others to undertake AMI training and to promote our courses to our community and others who may be interested. This consent form will authorise Sydney Montessori Training Centre to use and print photographs taken by SMTC, or shared with SMTC, in any form of media, including electronic, for educational, informational and promotional purposes that include my image or reference to me. In addition, photographs of my work that is shared with other participants on the course may from time to time also be publicly shared on media platforms to provide others with a sense of what is involved in the course. Individual work submitted privately and not shared with the course group is never shared in media. In all cases, names and personal details about an individual or the organisation they work for would not be disclosed with the photograph. This photo consent form will be kept on file by Sydney Montessori Training Centre as reference for individual approval.

Would you like to join SMTC's mailing list?*

Yes

I’m already subscribed

Signature*

I declare that the information I have provided above, to the best of my knowledge, is true and correct. (Please note that supplying false information may lead to dismissal from the course and a forfeit of fees.)

Advanced 3-6 Observation Program – Registration Form