QUEENSTOWN Learning Matters - Enrolment Form 2018
Student Enrolment Form for Assessments and Education Sessions 2018
Please note this form will include, for your information, the Learning Matters Terms and Conditions, including 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. Irrespective of whether or not you are intending to enrol for sessions, it is a requirement that this form is completed.

14b Fox’s Terrace Arrowtown, 9302
Mountain Ash Drive, Remarks Park, Queenstown

PH 027 LEARNIN (532 7646)

Bookings E admin@learningmatters.co.nz
Invoicing E accounts@learningmatters.co.nz

Student Name: *
Your answer
Date of Birth *
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 *
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?
Specific Learning Differences Identified:
Please email any supporting documents to admin@learningmatters.co.nz
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