Young Learner Online Booking Form – Loxdale English Centre

Name of Child *

First

Last

SEX

Male
Female

Date of Birth *

Student Email Address *

Parent/Guardian Information

Name of Parent or Guardian *

First

Last

Parent or Guardian Email Address *

Home Phone Number

Mobile Phone Number *

Do you (parent) speak English ? *

Yes
No

Course Details

Choose your favourite courses *

Tick your course choice in order of preference (the first choice is the one you want the most)

Start Date *

Number of Weeks

Number of Daily Sessions

Do you prefer a Morning or Afternoon class?

Morning
Afternoon
I don't mind

Parental Consent

Please tick all the health conditions that apply to your son or daughter.

Please tick all that apply *

Asthma or Bronchitis
A heart Condition
Epilepsy, fits, fainting, or blackouts
Severe headaches or migraines
Any history of mental health problems (including hyperactivity, depression)
Any learning difficulties (incl. dyslexia)

Is there anything else we should know? or would you like to provide more details?

Promotion, Informing & Training

To help promote our courses, show other parents and help with staff training, we may take a photo or video of the class occassionally. Will you allow this?

Photos

For Instagram
For Facebook
For our Website
For Training

Videos

For Instagram
For Facebook
For our Website
For Training

Security

Please accept all our conditions *

I accept that the school or teacher will e-mail my child to discuss their classwork. I will recieve a copy of any e-mails sent
I will not give the class sign-in information to any other person.
I realise that no parent is allowed to sign into the class. They are welcome to be in the background of the room for parts of the class.
I accept that these sessions are live streamed classes.

Payment

I understand that I must transfer the full course fees before I receive the sign-in information for my childs class *

Yes

Once completed, please sign this form and e-mail to Loxdale *

I have read and accept the terms and conditions of this School. I and my child have read and accept the class rules shown in the Online Code of Conduct and realise that Loxdale we will let you know if there are concerns about your child’s behaviour.

Signature *

Today's Date *