SpLD Teaching Registration Form

Student Registration Form

Fill out the form carefully for registration
Student Name

First NameLast Name
Birth Date

MonthDayYear
School Attended
School Year
Permission is given to share information with my child's school.
Parent / Carer(s) Name*

First NameLast Name
Parent / Carer E-mail*
Parent Mobile Number*
Address

Street Address

Street Address Line 2

CityCounty

Post Code
Please indicate which SpLD Session(s) you require*
Lessons are delivered in 30 minute sessions. If you would like both then this will be twice per week.
Please list any medical conditions, disabilities including allergies your child may have.
Is there any other information that you think we should be aware of?
Please include any diagnosis of SpLD or concerns if not formally diagnoised.
Please be aware that feedback will be via West Hill Park School as part of their normal reporting.

NOTE: If your child has a diagnosis please email a copy of their report to jan@sotontuition.com this will enable us to better support your child.
Please enroll my child:*

Clear
Date*

DayMonthYear
Date
Should be Empty:

Student Registration Form