Student Registration Form

Dyadm Academy

A Passion For Learning

info@dyadmacademy.com

www.dyadmacademy.com

0208 323 8855
Registration Form
Please note if the applicant registering is under 18 years of age, this form must be completed by both the parent/guardian as well as the applicant seeking tuition lessons.
- Full Name
  
  First NameLast Name
- Gender
- Educational Stage
- Year Level
  e.g. Year 1
- Email
- Phone Number
  Format: 00000000000.
- Age
- Birth Date
  
  MonthDayYear
- Parent/Guardian Information
- Title
- Full Name
  
  First NameLast Name
- Home Address
  
  Street Address
  
  Street Address Line 2
  
  CityCounty
  
  Post CodeCountry
- Parental Consent
- Do you give consent for the student named on this form to register with Dyadm Academy?
- Relationship
  ex. Father, Mother, Guardian etc.
- Parent Phone Number
  Format: 00000000000.
- Emergency Contact
  
  First NameLast Name
- Phone Number Of Person To Contact In Case Of Emergency
  Format: 00000000000.
- Email Of Person To Contact In Case Of Emergency
  example@example.com
- This section should be completed by the applicant with the support of a parent/guardian if necessary.
- School/College Name
- School/College Location
- What level of study are you currently on?
- Which of these subjects do you find most challenging?
  
  Other (please specify below)
- What do you find most challenging about the subject(s) you have selected above?
- Please select the subject(s) you would like to register for tuition lessons. You can add to the list at a later stage if needed.
  
  Other (please specify below)
- Please list the subject(s) you wish to tutor for?
  You can update this list at a later stage if needed.
- Please state if you are on lower or higher tier for the subject you wish to tutor for (if applicable)?
- Do you have any mock exams or assessments approaching on the subject you wish to receive tuition for? If so, please provide dates/period of the upcoming assessment(s) below:
- Do you plan to shift to another course?
- Which course do you plan to change to?
- What is your first choice for university?
- What course do you plan to study at university?
- What is your plan after college/sixth form?
- Extra Curricular Participation
  
  Other (please specify below)
- Student Profile Photo
  
  File should be in jpeg, png format.
  Cancelof
- Which of these device(s) will you mostly use to access tuition lessons?
- Do you have a G-mail account?
  A Google account is required to access online sessions. If you do not currently have a G-mail account, you may proceed with the registration. You can set this up at a later date
- If you have a Gmail account please provide your address here
- Are you confident using Google Drive Services (including Google Classroom)?
  We use Google Classroom and Google Meet to host all online sessions and to manage course materials
- Do you consider yourself to have a physical/learning disability?
- If yes, do you require special accommodation(s) based on your physical and/or learning disability? Please specify below
- Skills/Talents
  
  Other (please specify below)
- Sports
  
  Other (please specify below)
- Other Interests
- Additional Comments
- How did you hear about us?
  
  Other (please specify)
- Informed Consent and Acknowledgement
- PARENTAL CONSENT
  
  I hereby grant permission for my child's participation in Tuition Arrangements organized by Dyadm Academy.
  
  In the event of any injury to my child, I release Dyadm Academy, along with all its directors, staff, and agents from any claims.
  
  By registering with Dyadm Academy, I provide consent for the processing of the personal data I have provided, as outlined in the relevant privacy notice. I acknowledge that Dyadm Academy fully complies with the Data Protection Act 1998 and The General Data Protection Regulation (GDPR) 2018, and my personal information will only be shared with third parties when necessary to fulfill its services.
  
  By submitting this form, I confirm that I have read Dyadm Academy's Terms and Conditions of Business and I agree to abide by these terms.
- Confirmation
  
  BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
- By registering with Dyadm Academy, I provide consent for the processing of the personal data I have provided, as outlined in the relevant privacy notice. I acknowledge that Dyadm Academy fully complies with the Data Protection Act 1998 and The General Data Protection Regulation (GDPR) 2018, and my personal information will only be shared with third parties when necessary to fulfill its services.
  
  In the event of any injury to myself, I release Dyadm Academy, along with all its directors, staff, and agents from any claims.
  
  By submitting this form, I confirm that I have read Dyadm Academy's Terms and Conditions of Business and I agree to abide by these terms.
- Parent/Guardian Signature
- Applicant Signature
- Please verify that you are human
- Should be Empty:

Registration Form

Parent/Guardian Information

Parental Consent

Informed Consent and Acknowledgement