Registration Form
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Student Name
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First Name
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Gender
*
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Male
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Home Address
*
Street Address
Street Address Line 2
City
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School Name
*
Year Group
*
SEN (Special Educational Need)
*
Please provide information on child's SEN needs (If Yes).
Parent & Guardian Details
E-mail
*
example@example.com
Mobile Number
*
Emergency Contact
*
First Name
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Emergency Contact Phone Number
*
Please enter a valid phone number.
Medical Needs?
Additional Comments
My Products
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( X )
Football Package
Per week. 1 hour group football sessions. Only on Tuesday evenings. (First Session Free).
£
30.00
Quantity
1
2
3
4
5
6
7
8
9
10
Silver Package: Tutoring
Per week. 4 hours Tutoring (2hrs English + 2 hours Maths). Physical Learning. Flexible days in the week.
£
50.00
Quantity
1
2
3
4
5
6
7
8
9
10
Silver Package: Virtual Tutoring
Per week 4 hours Tutoring (2hrs English + 2 hours Maths).Online Learning. Flexible days in the week.
£
60.00
Quantity
1
2
3
4
5
6
7
8
9
10
Platinum Package: Tutoring & Football
Per week. 4 hours Tutoring (2hrs English + 2 hours Maths) + 1 hour Football Physical Learning. Flexible days in the week.
£
70.00
Quantity
1
2
3
4
5
6
7
8
9
10
Platinum Package: Virtual Tutoring + Football
Per week. 4 hours tutoring (2 hours English + 2 hours Maths) + 1 hour Football. Online Learning Flexible days in the week.
£
80.00
Quantity
1
2
3
4
5
6
7
8
9
10
Gold Package 11+ tutoring
Per Week. 6 hours tutoring (3 hours English + 3 hours Maths). Physical / Online Learning
£
100.00
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card Details
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Security Code
Card Expiration
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