Tuition - Get Ahead Learning - Student Profile Agreement

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Student Profile Agreement

Please use a separate enquiry for each student.

I/we have read, understood and agree with the fees/conditions of Get Ahead Learning on:

/ /

Student's Surname:
Student's Given Names:
Students Date of Birth:	/ /
Parents/Guardian Name (1):
Parents/Guardian Name (2):
Home Phone:	( )
Mobile Phone:
Home Address:
City:
State:
Postcode:
Billing Address: (if different to Home Address)
City:
State:
Postcode:
Work Occupation:
Email:

Student wears glasses:	Yes No
If yes, please provide details:
Does Your Child Attend Any Other Professional Services?: e.g. Speech Therapy	Yes No
If yes, please specify:
Student Medical Conditions/Allergies:

Alternative Contact Person in case of an Emergency
Name:
Relationship to Student:
Phone:	( )
Other Important Information:

Tuition Payment Method:
Cash Cheque Direct Deposit Credit Card

I/we give permission for my/our son/daughter to have their photograph taken and their name displayed on the Get Ahead Learning website and in any other advertising material. Yes No
I/we give permission for my/our son/daughter to to be named and included in the Congratulations Corner, a competent of the Get Ahead Learning Newsletter and a Results Corner Board displayed in the centres: Yes No

Enter your name if all details are correct:

Today's Date / /

Confidentiality: Get Ahead Learning (formerly Fiona Young Tuition) regards this enrolment enquiry as a confidential document. But we reserve the right to use your information for the purpose of communicating with you. If you would prefer us not to use your details to communicate with you please tick here

Please Enter Code
*Security question, designed to stop automated spam bots

Please click to submit your enquiry

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