Registration

Top-Up Tuition

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/CarerAddressPhoneEmailDo you give permission for your child/children to walk home alone? Yes/NoPlease state who will be collecting your child/children

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 *GenderDietry requirements

Does you child receive Free School Meals ? *

YesNo

Any known allergies? *Does 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

Picture Consent *

YesNo

Tutoring options and subjects

Please state which subject you would like your child/children to take, although we do recommend taking both; English and MathsAdditional CommentsPlease specify days and times that you would prefer for your child/childrens sessions. We will confirm these times before the start date.

Terms and Conditions

Additional Comments

Declaration

Data Consent *

Yes

Sign *