HELPING HANDS REGISTRATION FORM

REGISTRATION FORM

Helping Hands Educational Center|#7 Grant’s Plaza Downtown, Providenciales Turks and Caicos Islands| Email: helpinghands.educ@gmail.com |Contact: (649)331-4958| “Nurturing Potentials into Excellence”
Name

First NameLast Name
Gender
Date of Birth

DayMonthYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Nationality
School
Grade
Mother's name

First NameLast Name
Address
(Cel.)
Email Address
example@example.com
Place of Work
Occupation
Father's name
Address
Telephone number: (Work)
Format: (000) 000-0000.
(Cel.)
Email Address
example@example.com
Place of Work
Occupation
Person (other than parent) allowed to pick up child
Name

First NameLast Name
Relationship
Contact
N.B-Children under the age of 10 years old must be accompanied to the center by parent/guardian. All students must be picked up by parent/guardian. No child will be allowed to leave without the presence of an authorized adult (as indicated above).
NUMBER OF TUTORING SESSIONS(Weekly)
TUTORING DAYS PREFERRED (subject to availability)
TIME PREFERRED( You can select more than one options; subject to availability)
TUTORING SUBJECT(S)

Other
Additional Comments/Requests about the child
Commencement date

DayMonthYear
Date
Date

DayMonthYear
Date
Signature
Should be Empty: