January Course Program

January Intake

Registration Form

Coder's Name*

First Last

Level of Education*

Name of School*

Do you have any knowledge in Programming

YesNo

Preferred Program to Enroll

Parent/Guardian Information

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityCity/ County

Postal / Zip CodeCountry

Home Number*

Area CodePhone Number

Cell Number*

Area CodePhone Number

E-mail*

Emergency Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Area CodePhone Number

Alt. Phone Number*

Area CodePhone Number

Does your kid have any prior programming knowledge*

YesNo

Provide additional information about student's hobbies and activities*

Confirmation

BY ACKNOWLEDGING AND SUBMITING BELOW, I AM ACCEPTING KNODEMY TERMS OF USE AND PRIVACY POLICY AND 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.

Novelle Innovation & Tech Center

United Bible Societies, Ndemi Road.
254-7-NOVELLE (+254 729 717 002)

www.novelletech.com