Geek School Registration Form

Please complete the registration form enclosed to complete your child’s registration with Geek School Tutoring.

Form for parents

Child's Full Name*
First Last
Child's Date of Birth*
Date Format: DD slash MM slash YYYY
Address
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Mother's Full Name
Mother's Address*
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Mother's Mobile Phone Number*
Father's full name*
Father's Address*
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Father's Mobile Phone Number*
Name of GP*
First Last
Name of School*
Are Children's Services (Social Services) involved with your family?*
Name of Social Worker
First Last
Do you agree with the Geek School Terms and Conditions (please read the T&Cs here: https://www.geekschool.co.uk/terms-and-conditions-2/)*
- Yes
Signature*
Please type in your full name
Date*
Date Format: DD slash MM slash YYYY
Name
This field is for validation purposes and should be left unchanged.