Booster Booking Form

Booster Course Booking Form

Monday, Tuesday or Wednesday 5:30pm - 6:30pm
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 select the days you would like to attend:

Monday 3rd AprilWednesday 29th MarchMonday 17th AprilWednesday 19th AprilMonday 24th AprilWednesday 26th AprilMonday 1st MayWednesday 3rd MayWednesday 10th MayMonday 15th MayWednesday 17th MayMonday 22nd MayWednesday 24th May
Please tick what you would particularly like your child to work on.

Correct finger placementSpeed (wpm)Both
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 this website store my submitted information so they can respond to my enquiry.
PAYMENT

Please make the payment of £18 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: touchtype@qwertykids.org or if you would like to speak to us then please ask and we will be happy to call you.
Should be Empty:

Booster Course Booking Form

STUDENT'S INFORMATION:

PARENT/GUARDIAN INFORMATION:

COURSE INFORMATION