Booster Booking Form

STUDENT'S INFORMATION:
Student's Name

First NameLast Name
Date of Birth

DayMonthYear
Student's Age & School Year
Name of School
Student's email
example@example.com
Does your child have any specific learning difficulties?
Any allergies or medical information that we should be aware of?
PARENT/GUARDIAN INFORMATION:
Parent/Guardian's Name

PrefixFirst NameLast Name
Mobile Number
Landline
E-mail*
Emergency Contact (Name and Number)
COURSE INFORMATION
Please tick what you would particularly like your child to work on.

Correct finger placementSpeed (wpm)Both
Please state the days you would like to attend:

Monday 6th January (5:30pm - 6:30pm)Tuesday 7th January (5:30pm - 6:30pm)Monday 13th January (5:30pm - 6:30pm)Tuesday 14th January (5:30pm - 6:30pm)Monday 20th January (5:30pm - 6:30pm)Tuesday 21st January (5:30pm - 6:30pm)Monday 27th January (5:30pm - 6:30pm)Tuesday 28th January (5:30pm - 6:30pm)Monday 3rd February (5:30pm - 6:30pm)Tuesday 4th February (5:30pm - 6:30pm)Monday 10th February (5:30pm - 6:30pm)Tuesday 11th February (5:30pm - 6:30pm)Other
Please specify if there are any letters/punctuation etc. that your child knows they find tricky.
Please state if you would be happy for your child's photo to be taken and used in our promotional material.

YesNo
GDPR Agreement

I consent to having QWERTY Type store my submitted information so they can respond to my enquiry.
PAYMENT

Please make the payment of £20 a session to:

Account name: QWERTYkids

Sort code: 40-20-10

Account no: 81667335
Cancellation Policy: Once payment has been made we are unfortunately unable to refund the cost of the sessions.
Any questions at all please do not hesitate to contact Clare or Philippa by email: learn@qwertytype.com or if you would like to speak to us then please ask and we will be happy to call you.
Should be Empty:

STUDENT'S INFORMATION:

PARENT/GUARDIAN INFORMATION:

COURSE INFORMATION