Student Registration Form

This form must be completed by parents or guardians when enrolling a student at Edurium. The information provided will be kept confidential and used only for administrative and safeguarding purposes.

Student Registration Form

Student Information

Full Name of Student

Date of Birth

MM slash DD slash YYYY

Current School

Year Group

3456

Subjects Required

MathsEnglishScience

Preferred Centre

WhittonTwickenham

Parent/Guardian Information

Full Name of Parent/Guardian

Relationship to Student

MotherFatherGuardianOther

Home Address

Contact Number

Email Address

Medical and Emergency Information

Medical Conditions / Allergies (if any)

Emergency Contact Name

Emergency Contact Number

Doctor’s Name

Doctor’s Surgery Contact Number

Consent

Consent & Agreement I confirm that the information provided in this registration form is accurate and complete. I agree to comply with Edurium’s policies and procedures, including safeguarding, health & safety, fees & payment, attendance, and assessment policies. I understand that tuition will only commence once the registration fee and first month’s payment have been made.

Parent/Guardian Signature

Date

MM slash DD slash YYYY