REGISTRATION FORM
Today's Date
Name
Mr
Mrs
Ms
Miss
Dr
Other
Email
Telephone
Fax
Address
Postcode
STUDENT DETAILS
Name of Student
(if different from above)
Male
Female
Date of Birth
Age
BOOKING
What days are you
required for lessons?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
How many hours of lessons did you book at a time?
How many hours of lessons have you paid for?
What is your lesson time?
Weekday
3.45 to 4.45
4.50 to 5.50
5.55 to 6.55
Saturday
9.00 to 10.00
10.00 to 11.00
11.00 to 12.00
12.00 to 1pm
1.00 to 2.00
2.00 to 3.00
3.00 to 4.00
4.00 to 5.00
5.00 to 6.00
Sunday
9.00 to 10.00
10.00 to 11.00
2.00 to 3.00
3.00 to 4.00
4.00 to 5.00
5.00 to 6.00
EXAMINATIONS
Do you have any forthcoming examination(s)?
Yes
No
If yes, which examination(s)?
Date of examination(s) (if known)