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Step 1 of 6 Student / Learner Information

Student Details

First Name

Last Name

Date of Birth

DD / MM / YYYY. This determines which sections of the form you need to complete.

Day

Month

Year

Student Email

Optional for students under 16.

Student Mobile Number

Optional for students under 16. UK mobile or landline.

Address

Does the student live at a different address from the parent/guardian?

Yes

No

Student Home Address

Postcode

Address line 1

Address line 2

Town / City

County

Education

Current School / College

Current School / College Year

Please specify

Step 2 of 6 Tuition Requirements

Step 3 of 6 Additional Learning & Medical Information

Additional Learning Needs

Does the student have any Special Educational Needs (SEN), disabilities, learning needs or additional support requirements that we should be aware of?

Yes

No

Please provide relevant details

Please tell us about any relevant needs, support currently in place, or anything that helps the student learn effectively.

Medical Information

Does the student have any medical conditions, allergies, medication or health needs that we should be aware of to help keep them safe while attending the Centre?

Yes

No

Please provide relevant details

Please include any information that staff need to be aware of while the student is attending Bury Tuition Centre.

Medication

Will the student need to bring, self-administer or have medication available while attending the Centre?

Yes

No

Please provide brief details

Important

Where medication is to be held or administered by the Centre, a separate medication consent and administration form must be completed before staff can administer any medication. This enrolment form does not replace that separate medication record.

Step 4 of 6 Parent / Guardian & Emergency Contact

Parent / Guardian

This section is required for learners under 18.

First Name

Last Name

Relationship to Student

Please specify the relationship

Email Address

Your enrolment confirmation will be sent to this address.

Mobile Number

Home Address

Postcode

Address line 1

Address line 2

Town / City

County

Emergency Contact

Please note

The emergency contact should preferably be a different responsible adult from the person completing this form, where practicable.

Emergency Contact Name

Relationship to Student

Emergency Contact Mobile Number

Step 5 of 6 Collection & Safeguarding Arrangements

Collection Arrangements

These questions apply to learners under 16.

How will the student normally leave the Centre?

Select all that apply.

Collected by parent/guardian

Collected by another authorised adult

Allowed to leave independently

Other arrangement

Name(s) of authorised adult(s) who may collect the student

Please list each authorised adult on a new line.

Are there any collection instructions, restrictions or other arrangements we need to be aware of?

Optional, unless you selected "Other arrangement" above.

Sibling Information

Does the student have any siblings?

Yes

No

Sibling 1

Sibling Name

School Year

How Did You Hear About Us?

How did you hear about us?

Optional.

Please specify

Step 6 of 6 Policies, Permissions & Consent

Policies & Mandatory Acknowledgements

Each policy title opens in a new tab so you will not lose your place in this form. None of these boxes are ticked for you.

Complaints Procedure

You can read how to raise a concern or complaint at any time. You do not need to agree to this as part of enrolment.

Photography & Video

Photography & Video Consent

I consent to photographs/video being used for internal educational or classroom purposes only.

I consent to photographs/video being used for internal purposes and external promotional purposes, including the Bury Tuition Centre website, social media and promotional materials.

I do not consent to photographs or video of the student.

Optional Marketing Communications

Final Declaration & Electronic Signature

Full Name of Person Completing Form

Typing your full name here acts as your electronic signature.

Relationship to Student

Please specify

Bury Tuition Centre is part of / operated by North West Education Hub Ltd. By submitting this form you are entering into an enrolment with that organisation, which is the data controller for the information you provide.

Bury Tuition Centre Online Student Enrolment Form

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Step 1 of 6 Student / Learner Information

Student Details

Address

Education

Step 2 of 6 Tuition Requirements

Tuition Required

Availability

Step 3 of 6 Additional Learning & Medical Information

Additional Learning Needs

Medical Information

Medication

Step 4 of 6 Parent / Guardian & Emergency Contact

Parent / Guardian

Emergency Contact

Step 5 of 6 Collection & Safeguarding Arrangements

Collection Arrangements

Sibling Information

How Did You Hear About Us?

Step 6 of 6 Policies, Permissions & Consent

Policies & Mandatory Acknowledgements

Photography & Video

Optional Marketing Communications

Final Declaration & Electronic Signature