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Learner Information Form

Who are you completing this form as?

Parent / Guardian

Adult Learner (18+)

*Parent/Guardian First Name

*Parent/Guardian Last Name

*Email

*Phone

Multi-line address

*Country/Region

*Address

*City

*Zip / Postal code

*Is the person completing this form also the payer?

Yes

No

*Payer First Name

*Payer Last Name

*Payer Email Address

Payer Address

*Country/Region

*Address

*City

*Zip / Postal code

*Learner First Name

*Learner Last Name

*Learner Birthday

Day

Month

Year

*Which year group is the student currently in?

Year 3

Year 4

Year 5

Year 6

Year 7

Year 8

Year 9

Year 10

Year 11

Other

*Which course or programme is the learner registered for?

Maths – UK School Curriculum

English – UK School Curriculum

Science – UK School Curriculum

English as an Additional Language (EAL)

11+ Preparation

GCSE English

GCSE Maths

GCSE Science

Adult English / Conversation English

Adult Maths

Functional Skills Maths

Functional Skills English

Persian (Farsi) as a Second Language

Other

*How did you hear about our online classes?

Instagram

Facebook

YouTube

Google

Flyers & Leaflets

Friend/Family recommendation

Other

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I have read and agree to Learninet’s Terms and Conditions.

I have read Learninet’s Privacy Policy.

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