Application Form
Please submit this completed form to us and if we currently have space we will ask you to pay an application Fee of £50, which includes payment for two ‘taster’ days.

Please do not transfer money before confirming that there is space – if we have no space we will add you to our waiting list. We will contact you to arrange a taster session and/or a meeting with a senior tutor as soon as we can.

Payment may be made by cheque or by direct bank transfer to:

The Canterbury Lernejo Ltd. sort code 08-92-99 Account No. 65685457

About the child/student
The following details should be completed to provide information and background to the prospective child/student.
Surname
Your answer
Forname(s)
Your answer
Gender
Date of Birth
MM
/
DD
/
YYYY
Background
Please outline the student’s temperament, skills and achievements, and also any personal problems or educational needs.
Background
Your answer
Additional information
Please outline your needs, hopes and goals for the young person and how you are hoping we, at the Lernejo, can help.
Goals
Your answer
Subjects of interest (if GCSE courses have already been started, please give details)
Your answer
Medical problems, health or dietary needs we need to be aware of?
Your answer
Full time or part time
If we are able to offer you a place, when would you like to start?
MM
/
DD
/
YYYY
Parent / Guardian 1
Full name
Your answer
Relationship to child
Your answer
Address
Your answer
Telephone numbers (work/home and mobile)
Your answer
Email address
Your answer
Occupation
Your answer
Signed (use email address)
Your answer
Date
MM
/
DD
/
YYYY
Parent/Guardian 2
Full name
Your answer
Relationship to child
Your answer
Address (if different to above)
Your answer
Telephone numbers (work/home and mobile)
Your answer
Email address
Your answer
Occupation
Your answer
Signed (use email address)
Your answer
Date
MM
/
DD
/
YYYY
Submit
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