Tuition Students - Registration Tuition FormStudent Registration for TuitionFirst NameMiddle NameLast NameFirst LanguageSecond LanguageEthnicityChild numberChilds PositionDate of BirthAgeGender- Select -MaleFemaleSchool (Which school do they attend for the National Curriculum?)School year?- Select -Year 2Year 3Year 4Year 5Year 6Year 7Year 8Year 9Year 10Year 11Year 12Year 13Which day would you like your child to attend- Select -Thursday 5pm to 7pmFriday 5pm to 7pmSaturday 4pm to 6pmSunday 4pm to 6pmAny specific area of focus?Which subject would you like to work on? KS2 MathsKS2 EnglishKS3 MathsKS3 EnglishKS3 ScienceGCSE AQA MathsGCSE Edexcel MathsGCSE AQA EnglishGCSE Edexcel EnglishGCSE Edexcel Seperate SciencesGCSE AQA Separate SciencesGCSE Combined Sciences HigherGCSE Combined Science FoundationFathers informationFirst NameMiddle NameLast NamePhone/MobileEmailFirst LanguageSecond LanguageOccupationAddress (if different)Mothers informationFirst NameMiddle NameLast NamePhone/MobileEmailFirst LangaugeSecond LanguageOccupationSpecial Educational Needs (SEN) Please write details of any conditions, e.g., dyslexia, autism, etc., your child has. Please provide the school with a copy of any relevant SEN reports or ILPs (Individual Learning Plans) your child has. Write here:Please include a copy of child’s relevant SEN documentsChoose File Medical Notes Please write details of any medical conditions, e.g., asthma, epilepsy, allergies, diabetes etc., your child has. Please provide details of any medicine your child takes regularly or in emergencies. Write medical notes here:SAMA Academy We may use audio or visual recording in learning activities or occasionally for promotional purposes – please indicate below whether you want to ‘Opt in’ or Opt out’ : Consent- Select -Opt inOpt OutGCSE Students If you are a GCSE Student, please list below the works of literature you are studying for English Literature. Please ensure you have chosen the correct exam board and subjects in the previous section. Anything you would like to add? Declaration I declare all the information provided above to be true and complete. Full NameRelation to StudentSignature Sign Here Date signedSubmit
