Elevate Club - Registration form

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The information requested here is essential for communications with both parents & students and setting up user accounts.

Which Elevate Club *

Hinchley Wood - Friday 13:20

Refresh, East Molesey. - Wednesday 15:30

Parent's name *

Address *

Parent's mobile number (please input spaces in the number for example 07904 SPACE 831245) *

Parent's email *

Student's first name *

Student's surname *

Student's current school year *

Year 7

Year 8

Year 9

Year 10

Year 11

Option 1

Clear selection

Option 1

Clear selection

Option 1

Clear selection

Students date of birth

YYYY

Student's mobile number (please input spaces in the number for example 07904 SPACE 831245) *

Student's email - Student need their own email address - This is ESSENTIAL. *

Can your child bring in a laptop every week? Us *

Yes

How 'happy' is your child about attending the Club. *

Very unhappy

Very Happy

Please supply any information we should know to help us support your child. There isn't any need to send full reports, as we screen all the student to establish their individual learning plan.

I agree to support my child in applying the skills learned at Elevate Club at home. This involves regular practice with the technical solutions and utilising the strategies taught. *

Yes

To secure your child's place we need a £50 deposit. Please select how you have paid this.

I have completed a bank transfer to: Nat West 60-08-04 56582889 (use child's name as reference)

I have posted a cheque to Elevate Eleven, 2, Rosehill, Claygate, Esher KT10 0HL

Clear selection

Any instructions for when the class is over? To be completed if you are not happy for them to leave independently

Submit

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