The Enrichment Centre - Tuition registration form
Please complete all required fields on the form
Email address *
Student details
Forename *
Your answer
Surname *
Your answer
Address *
Your answer
Post code *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Sex *
Required
Details of other siblings to register (Name & DOB)
Your answer
Please state which programmes you are interested in *
Required
Please select subjects you are interested in for Primary Tuition *
Required
Please select subjects you are interested in for Secondary Tuition *
Required
Does your child have a social worker *
Parent/Guardian (1)
Name *
Your answer
Relationship to child *
Your answer
Contact number *
Your answer
Contact email *
Your answer
Parent/Guardian (2)
Name *
Your answer
Relationship to child *
Your answer
Contact number *
Your answer
Contact email *
Your answer
Medical information
Does your child/children have any medical illnesses, allergies? *
Your answer
Additional information
Your answer
Emergency contact 1
Name *
Your answer
Relationship to child *
Your answer
Contact number *
Your answer
Contact email *
Your answer
Emergency contact 2
Contact number *
Your answer
Contact email
Your answer
Relationship to child *
Your answer
Declaration
*
Required
Advertising and monitoring
How did you find out about The Enrichment Centre
Your answer
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