form1

First Name*

Last Name*

Street Address

Street Address (continued)

City

Postcode

Select GenderMaleFemale

DOB

School Name

Year Group

Medical CondititonsYesNo

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Current Academic Level - English (if known)

Current Academic Level - Maths (if known)

Current Academic Level - Science (if known)

Should your child be allowed to travel home alone after class?YesNo

Any Specials NeedsYesNo

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Any further comments

PARENT/GUARDIAN DETAILS

Full Name*

Relationship to Student

Tel (Home)

Tel (Mobile)

Email

Subject Of Study (please tick)EnglishMathScience

Preparation For (please tick)KS1KS2KS3GCSEGCSE

How did you hear about us?

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ieducate Centre caters for children aged 5-16 years (11+, Key Stage One to GCSE).