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BAY OF PLENTY Learning Matters - Enrolment Form 2019
Student Enrolment Form for Assessments and Education Sessions 2019
Please note this form includes, for your information, the Learning Matters Terms and Conditions, including our Enrolment period, Financial information and Learning Matters semester dates. Following your child's assessment, the assessor will give a recommendation of session type and frequency.

Our Tauranga centre is located on 172 Waihi Road TAURANGA, 3110


PH 027 LEARNIN (532 7646)
www.learningmatters.co.nz

Your point of contact for invoicing is our financial administrator, Kayla
accounts@learningmatters.co.nz

Student Name: *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
School Currently Attending *
Your answer
Year Level *
Parent / Caregiver Name(s) *
Your answer
Parent Contact Phone Number *
Your answer
Email Address *
Your answer
Home Address *
Your answer
Emergency Name and Contact *
In case of Emergency and the parent is unable to be contacted, please share the details of the next person to contact
Your answer
Emergency person's contact number *
Your answer
Enrolling in *
Required
Behavioural Concerns or Conditions *
Does your child present with any behavioural concerns or is diagnosed with any behavioural conditions?
Your answer
Previous remediation, support, interventions *
Has your child had any previous tutoring, in school support, out of school support, other assessments?
Required
Specific Learning Differences Identified: *
Please ensure any supporting documents are forwarded to your child's assessor and educator.
Required
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