Moka Success English Registration Form

Fun with English

Learn to Love to Learn.
Student registration details
Student's Name

First NameLast Name
Birth Date

MonthDayYear
School Grade/ Year
Gender

MaleFemale
Parent/Guardian Information
Please fill in the contact details below so that we can update your information for 2024.
Name

First NameLast Name
Mobile Number
E-mail
example@example.com
Which class would you like to register for?*
Choose 'I don't know' and we'll advice you about the best level for your child.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM CONFIRMING THAT I WOULD LIKE SUCCESS ENGLISH TO SAVE A PLACE FOR MY CHILD IN TERM 1 2024.

TERMLY FEES PAYABLE PER STUDENT (INCLUDES ALL RESOURCES AND OTHER ADMINISTRATIVE COSTS)

RS 6500/ TERM

RS 6000/TERM WITH SIBLING DISCOUNT
Date

MonthDayYear
Date
Signature

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Fun with English