Student Information

Please complete your details below.

"*" indicates required fields

Student Name*

First Last

What should the teacher call you?

Date of Birth*

Gender

Male

Female

Address*

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

Student's First Language*

Any other languages spoken (optional)

Parent's Name*

First Last

Parent's Email*

Parent's mobile (for emergency contact)*

Parent's Facebook Profile (for communication)

Any medical conditions we should be aware of (e.g. learning difficulties / epilepsy)

Student's interests and hobbies

Terms and Conditions*

I have read and agree to the terms and conditions

I have read and agree to the data protection terms as per the privacy policy

By completing this form, you consent to us securely storing your information for the purposes of communicating with you about your or your child’s English classes. We will not pass your details to any 3rd party, or use the details for any other purpose.

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