Aunty Dory’s Institute Registration Form
The New Age of Learning
Student’s Name
First Name
Last Name
D.O.B
-
Month
-
Day
Year
Date
Gender
Female
Male
Address
Street Address
Street Address Line 2
Parish
Postal / Zip Code
Name of School
Class/Form
Student’s Email Address
Allergies/Illnesses
Parent Contact Information
Parent’s Name
First Name
Last Name
Relationship
Mother
Father
Other
If Other Please State
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Address
Street Address
Street Address Line 2
City
Parish
Postal / Zip Code
Services
More than one service can be selected.
Services Offered
11+ Preparation One on One Session
11+ Preparation Group Session
CSEC Mathematics One on One Session
CSEC Mathematics Group Session
CSEC Principle Of Accounts One on One Session
CSEC Principle Of Accounts Group Session
Supervised Blended Online Learning
Assessments
CSEC English A One on One Session
CSEC English B One on One Session
CSEC English A Group Session
CSEC English B Group Session
Emergency Contact
Name Of Emergency Contact
First Name
Last Name
Relationship
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Address
Street Address
Street Address Line 2
City
Parish
Postal / Zip Code
Submit
Should be Empty: