Hampshire Achieves Family Learning Course Enrolment Form 2020/21

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Boogie Mites School Ready/Minis/Teenies/Babies/SEN Courses

Title *

Miss

Mrs

Other:

Surname *

First Name *

Previous surname (if applicable)

Are you? *

Male

Female

Your Date of Birth *

YYYY

Child's First Name *

Child's Date of Birth *

YYYY

Is your child? *

Male

Female

Home address - Street 1 *

Home address - Street 2

Home address - City *

Home address - County *

Home address - Postcode *

Previous postcode (if changed within the last 3 years)

Mobile Phone Number *

Home Phone Number

Work Phone Number

Have you attended any other course in the last 3 years? *

Yes

Are you a UK national or a person with right of abode in the UK and have been ordinarily resident in the UK for at least three years at the start of this course? *

Yes

From the options below, please tick the box you feel best describes your ethnic origin: *

White - English/Welsh/Scottish/Northern Irish/British

White - Irish

White - Gipsy or Irish Traveller

White - any other white background

Mixed - White and Black Caribbean

Mixed - White and Black African

Mixed - White and Asian

Mixed - any other multiple ethnic background

Asian - Indian

Asian - Pakistani

Asian - Bangladeshi

Asian - Chinese

Asian - any other Asian background

Black - African

Black - Caribbean

Black - any other Black/African/Caribbean background

Other - Arab

Other - any other ethnic group

I prefer not to say

How confident do you feel about filling in forms? (If necessary, your tutor can help you to complete the forms that are part of this course). *

Very confident

Okay

Not very confident

What are your reason(s) for joining the course (tick as many as apply). *

1. To learn how music can support my child's development

2. To bond with my child through this shared experience

3. To link with other parents with children of a similar age

4. To obtain resources and knowledge to continue home practise

5. To start a learning journey for myself and find out what other courses are available to me

Other:

Required

Which course have you enrolled on? *

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