Summer Holiday Course Registration
Customer Details:
Parent's Name
*
First Name
Last Name
Child's Name
*
First Name
Last Name
Child's Year Group
*
Address
*
Street Address
Street Address Line 2
City
State / province
Postal / Zip Code
Parent's Phone Number
*
Parent's E-mail
*
example@example.com
How did you hear about us?
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Instagram
Local Facebook group
Recommendation
Other
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What level is your child working at in school?
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Below the expected year group standard
At the expected year group standard
Above the expected year group standard
Please tell me a bit about why you want your child to do these sessions along with any other information you'd like me to know about your child. I will contact you once you've booked to confirm further details:
My Products
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( X )
4 lesson crash course
£
75.00
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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