Advanced 3-6 Observation Program – Registration Form >Advanced 3-6 Observation Program – Registration Form Advanced 3-6 Observation Program Registration Form "*" indicates required fields FacebookThis field is for validation purposes and should be left unchanged.Personal DetailsWhich Advanced Observation course are you registering for?* 2026 with Amy Kirkham Personal DetailsName* First Last * Please use the name you would like to see on your certificate.Prefer to be called byEmail address* Mobile Phone Number*If you live outside of Australia please include the country code firstThis field is hidden when viewing the formMobile numberDate of birth* DD slash MM slash YYYY 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 AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Is your postal address different to your residential address?* Yes No Postal Address (if different from residential address) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Emergency contact detailsEmergency 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 firstThis field is hidden when viewing the formEmergency contact's mobileWorking with Children CheckFor Australian residents only.Working with Children Check Number:WWCC Expiry Date: DD slash MM slash YYYY Language and Cultural DiversityPlease 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 languageIf more than one language, select the language most spoken.Are you of Aboriginal or Torres Strait origin?* No Yes, Aboriginal Yes, Torres Strait Yes, Both Aboriginal and Torres Strait Individual Learning NeedsDo you consider yourself as having a disability, impairment or long-term medical condition that might affect your participation in this qualification?* No 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?* No Yes Please specify:EducationHave 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.*EmploymentWhat 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 studyHow 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 detailsPayment 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 to pay via electronic funds transfer (EFT). I will make payment online via credit card. If you are paying via credit card, this is possible after an invoice has been issued to you. This usually takes around 24 hours after your application is received on business days.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 AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Contact name for invoices First Last Email contact for invoices Organisation PhoneConsent* I agree to the SMTC Terms and Conditions and consent to the collection, use and disclosure of my personal information in accordance with the Privacy Notice.Terms & Conditions Privacy Notice 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 No 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.)