Student Information

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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

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