Cognitive training Registration Form
Fill out the form carefully for registration
Today's Date
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Parent / Carer's Name
*
First Name
Last Name
Phone Number
*
Format: 00000000000.
Emergency Contact
Format: 00000000000.
E-mail
*
example@example.com
Child's name
*
First Name
Last Name
DOB
*
Day/Month/Year
Sch. Year
*
Name of School Attending
Has your child been diagnosed with any of the following?
*
Please Select
ADHD
ADD
Dyslexia
Dyscalculia
Other
None
If you answered 'other', please provide more details below.
What are your main concerns regarding your child's education/abilities?
*
Address
*
Street Address
Street Address Line 2
Town
State / Province
Postal / Zip Code
PHOTO PERMISSION
As part of our communication activity, we use photography for promotional and/ or publicity purposes. I (the undersigned) give permission for photographs to be used for the following (please tick)
To appear in the tuition centre promotional brochures, leaflets, booklet, exhibitions and website
The image(s) will remain the property of Ace Learning Plus. Your contact details will remain strictly confidential and we will never pass on your details to any third party. I understand that while my child(ren) attends, the centre's rules must be abided by. Also, I will agree to collect my child(ren) from the centre at the end of each session or I will notify the centre of any change to that arrangement.
Terms and Conditions
You will pay a non-refundable assessment and consultation fee of £150 per child.
All fees are payable in advance, including monthly, termly and annual payments.
Ace Learning Plus accepts no liability for personal property or personal injury.
Ace Learning Plus reserves the right to cancel a course if it is under-subscribed. In this case, a student may choose to attend another course at Ace Learning Plus or to receive a full refund of fees paid.
Students should be aware that they are attending the Ace Learning Plus cognitive training and are expected to behave responsibly at all times. Any activity that could disturb other students or staff will result in immediate dismissal from the course.
Parents or guardians accept total liability for any damage the student causes to the premises.
Parents or guardians know that if your child misses a lesson, you must pay 100% of the total rate you are currently paying; we require this for quality purposes. On this model, we cannot sustain the business if there are unpaid absences. However, we allow your child to attend a catch-up training if available.
Parents and guardians must inform us before the 23rd of the month if they wish to leave; parents are liable to pay 100% of the fees for the month of departure. If you do not inform us before the 23rd of the month, you must pay 100% of the following month's fees. You must attend a leaving consultation before the 23rd at Ace Learning Plus centre and fill out our leaving form and feedback questionnaire.
If a parent wishes to freeze their account for one month, they must follow the same guidelines as leaving procedures by giving us notice before the 23rd of the month by filling out the Ace Learning Plus office form.
Fees paid within the agreed period may be subject to late charges.
Days chosen
Times Chosen
Parent’s Signature
Were you referred by someone? If yes, by who?
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