KTL Tuition Workshops | Auckland tutoring

COURSE ATTENDING

If other: what course will you be attending?

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Part 1: Student particulars (Please use BLOCK letters)

Student's full name

GENDER

EXAM PATHWAY

SCHOOL

YEAR LEVEL

PARENT/CAREGIVER'S NAME

POSTAL ADDRESS

FAMILY EMAIL ADDRESS

MAIN WORK EMAIL

PARENT'S MOBILE NUMBER

STUDENT'S MOBILE NUMBER

HOME NUMBER

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Part 2: (Please leave blank if none)

ANY LEARNING/HEALTH/ATTENTIONAL/BEHAVIOUR ISSUES

ANY FOOD INTOLERANCES

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Part 3: (Information particulars)

HOW DID YOU FIND OUT ABOUT KTL TUITION ?

Friend/Work Colleague Who?

School recommendation

Brochure

Internet Search

Other

PLEASE GIVE US DETAILS ABOUT YOUR SELECTION

IF YOU WOULD LIKE TO RECEIVE KIDZ THERAPY/KTL TUITION NEWS FROM TIME TO TIME

Yes

No

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PLEASE READ THE TERMS AND CONDITIONS CAREFULLY.

I have read and agree to the Terms and Conditions. Please ask for clarification of any points you are unsure of. This document is issued on 19/01/13 and supersedes any previous terms and conditions issued by KTL Tuition formerly known as Kidz Therapy Ltd.

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