Course Registration Form

Registration Form

Fill out the form carefully for registration
Student Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Gender*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
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*
Format: (000) 000-00000.
Emergency Contact *

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Medical Needs?
Additional Comments

My Products*

Football Package

Per week. 1 hour group football sessions. Only on Tuesday evenings. (First Session Free).

£30.00 Quantity

Silver Package: Tutoring

Per week. 4 hours Tutoring (2hrs English + 2 hours Maths). Physical Learning. Flexible days in the week.

£50.00 Quantity

Silver Package: Virtual Tutoring

Per week 4 hours Tutoring (2hrs English + 2 hours Maths).Online Learning. Flexible days in the week.

£60.00 Quantity

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

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

Gold Package 11+ tutoring

Per Week. 6 hours tutoring (3 hours English + 3 hours Maths). Physical / Online Learning

£100.00 Quantity

Enter coupon

Total

£0.00

Registration Form