Form ANTE/01

Tuition Enrolment Form

STUDENT PERSONAL INFORMATION *

Full Name: *

Gender: *

Male

Female

Date of Birth: *

Name & Address of Current School: *

Current School Year and Level of Study: *

CONTACT INFORMATION *

Land Line: *

Mobile: *

Email Address: *

Parent Email/Other Contact:

SIGNATURE *

After filling in this form and agreeing to the fees below, please sign and date.

Annual Fee KS2, KS3 & KS4 - £600.00 *

First Instalment - £300.00

Second Instalment - £150.00

Third Instalment - £150.00

Please Tick all the boxes to agree the terms of payment

Annual Fee Per Subject KS5 - £500.00 *

First Instalment - £250.00

First Instalment - £125.00

Signature: *

Reset Signature

Signature is required.

All students under 18 must be signed for by a parent/guardian.

Parent/Guardian Name: *

Relation to student: *

Todays Date: *

Data Protection

Personal information about you is required to be collected by A and N Tutorials so that we can contact and identify you. Personal data will be registered under 1998 data protection act. Any information given here will not be given to any inappropriate individuals or organisations.