English Course
5 week course
5 week course
Starting January 8th until February 7th
Options:
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Child's Information
Child's Full Name
*
First Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
Date
Address
*
Street Name
Number
City
State
Postal / Zip Code
Medical Conditions / Additional Comments:
(Optional)
Parents Information
1st Contact
*
Full Name
Phone Number
Email
*
example@example.com
2nd Contact
*
Full Name
Phone Number
Email
example@example.com
3rd Contact
Full Name
Phone Number
Additional Information
How would you categorise your child's current level of English?
Beginner level
Intermediate
Proficient
I don't know / prefer not to say
How did you hear about us?
Social Media
Advertising
Referral
Other
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Terms & Conditions
Terms and Conditions
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