Young Learner Online Booking Form
Name of Child
Date of Birth
Student Email Address
Name of Parent or Guardian
Parent or Guardian Email Address
Home Phone Number
Mobile Phone Number
Do you (parent) speak English ?
Choose your favourite courses
English with Team Building and Leadership
English with Football
English with Drama
English & Digital Media
English with Confidence & Wellbeing
English for Song Writing
English with Language Cert Exam
Tick your course choice in order of preference (the first choice is the one you want the most)
Number of Weeks
Number of Daily Sessions
Do you prefer a Morning or Afternoon class?
I don't mind
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?
For our Website
For our Website
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.
I understand that I must transfer the full course fees before I receive the sign-in information for my childs class
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.