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Contact Form
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HOME
COURSES
KS2 AGE 7-10
KS3 AGE 11-14
HS DIPLOMA
FEES
Contact Form
CORPORATE
ABOUT
BOOK NOW
Book Now NJ
gary
2021-01-05T13:43:41+00:00
Home Schooling Contact Form
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Students Details/Name
*
First
Last
Student Date of Birth
*
please separate with dashes
GENDER
*
Male
Female
Age of Student
*
Main Contact
*
Relationship to Pupil
*
Mother
Father
Carer
Parent/Carer Home Address
*
Residence
*
Can be contacted in emergency during the day?
*
YES
NO
If YES Please Indicate suitable numbers
*
Main Contact: (Only one main contact to be ticked)
*
Mother
Father
Carer
Main Contact Email Address
*
Previous School/Home School
*
Dates attended, please indicate from and until
*
please separate with dashes
Curriculum Used
*
I declare the information on this form to be correct to the best of my knowledge.
*
Date and Sign
Name
*
First
Last
Signed by
*
Mother
Father
Carer
Monthly Registration Fee
*
KS2 £45 Monthly (No support)
KS2 £99 Monthly (With support)
KS3 £65 Monthly (No support)
KS3 £125 Monthly (With support)
HS Diploma/ KS4 £150 Monthly (With support)
please tick
Registration fee paid?
*
Yes
No
First month fee paid?
*
Yes
No
Phone
Submit
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