Online Class Registration

Parent/Carer Information 1

Name of Parent/Carer *Address *Phone *Profession (optional)Email *Where did you hear about us (or recommended by)?

Parent/Carer Information 2

Name of Parent/CarerAddressPhoneEmail

How many children do you want to register

OneTwoThree

Child One Information

Child 1 Name *Date of Birth *Age *Name of School *Year in school *Ethnicity *First Native LanguageSecond Spoken LanguageGenderAddress of SchoolCountry of SchoolDoes your child have any special educational needs? If yes please stateDoes your child have any medical needs (e.g asthma, ADHD, ASD etc)? If yes please state

Speaking :

FluentGoodBasicNone

Listening :

FluentGoodBasicNone

Reading :

FluentGoodBasicNone

How long has your child been instructed in and/or studied in English?What English program and level has your child studied up to?Is English spoken or practiced at home?Is English practiced/ instructed /spoken outside of the child's school establishment?What Curriculum is your child currently following?

Has your child had any education in the British Curriculum? if so, how long?

YesNo

How Many YearsHow Many Months

Reason for tutoring with Harringtons Learning Centre

Moving to a new locationSeeking different educational opportunitiesTo complement my child's learning alongside their British mainstream educationMy child is being homeschooled and needs extra helpOther

Picture Consent *

YesNo

Additional Comments

Declaration

Data Consent *

Yes

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