Adult Education Registration

ADULT EDUCATION REGISTRATION
Program*
Mode of Study*
Are you interested in free computer training?*
Student Enrollment Information

This information is required to enroll you into our Adult Education Program.
Name*

First NameMiddle NameLast Name
Physical Address*

Estate

Street Address

City / TownCounty

Zip CodeCountry
Phone Number*

Country CodePhone Number
Email Address*
Date of Birth*

DayMonthYear
Year of Last School Attendance*
Select year when you last attended school
Emergency Contact Information

Please complete this information for one emergency contact person
Full Name*

First NameMiddle NameLast Name
Phone Number*

Country CodePhone Number
Relationship*
Physical Address*

Estate

Street Address

City / TownCounty

Zip CodeCountry
Highest Level of Education Completed*
Employment*
I agree to be enrolled as a student at Elara Educational Centre. I consent to Elara Educational Centre requesting a copy of my national identity card and my passport-sized photo for its records.

I understand that I must become acquainted with the policies of Elara Educational Centre, and in order to remain enrolled, I must be active online and in class, communicate with my instructors on a regular basis, take continuous assessment tests and end-of-semester exams, and follow the rules of Elara Educational Centre.

I agree to abide by the policies of the Elara Adult Education Program.
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ADULT EDUCATION REGISTRATION