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Parent / Guardian Details
Name
*
Address
Street Address
Phone
Email
*
Registration Date: dd/mm/yyyy
Where did you hear about us?
How many children would you like to register?
1
2
3
4
Student 1 Details
Child 1 Name
*
Gender
Male
Female
Date Of Birth: dd/mm/yyyy
What school or preschool does your child attend?
Has your child had lessons previously?
No
Yes
Where?
Why did you leave?
Student 2 Details
Child 2 Name
Gender
Male
Female
Date Of Birth: dd/mm/yyyy
What school or preschool does your child attend?
Has your child had lessons previously?
No
Yes
Where?
Why did you leave?
Student 3 Details
Child 2 Name
Gender
Male
Female
Date Of Birth: dd/mm/yyyy
What school or preschool does your child attend?
Has your child had lessons previously?
No
Yes
Where?
Why did you leave?
Student 4 Details
Child 2 Name
Gender
Male
Female
Date Of Birth: dd/mm/yyyy
What school or preschool does your child attend?
Has your child had lessons previously?
No
Yes
Where?
Why did you leave?
Medical / Emergency Contact
Are there any learning difficulties or medical conditions we should know about?
No
Yes
Please explain
Doctor's Name
Doctor's Phone Number
Emergency Contact Person
Relationship To Student
Emergency Contact Number
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