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CLC 50 min. tutorials*: Math Read & Spell Specialized Reading Programme for students with Dyslexia Comprehension Writing Working Memory Programme Keyboarding Skills

Registration

Students Name*:
Date of Birth*:
Age*:
Gender*: Male Female
Parent/Guardian - name and contact numbers*:
Name of current school*:
Current Grade or Year level*:
Phone (mc)*:
(mw)*:
(mh):
Phone (dc)*:
(dw)*:
(dh):
Email Address*:
Street Address*:
District*:
PO Box*:
Emergency Contact - Name*:
Emergency Contact Phone*:
Is the student allergic to any medications or foods or have any physical conditions (i.e. asthma, diabetes, etc.)?*
Additional Comments
 I consent that pictures and/or videos taken in centre of my child may be used for CLC promotional purposes only.
Participant/Guardian Signature*:
Date*:
Accept Terms of Policy and Procedures*:  Yes, I Accept.

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Cayman Learning Centre
Cayman Learning Centre