Tech Bloq Enrolment Form 2025-26

Tech Bloq Enrolment Form
A £25 non-refundable enrolment adminstration fee applies to all new applications. This fee covers the administrative work involved in reviewing your application and assessing suitability. Applications are reviewed once this fee is received. This allows us to give each application careful consideration and ensure we can meet each child’s needs before confirming a place.
Tuition SessionsHome Education SessionsSTEAM Sessions
If you have a referral code, please type it here:
Student Information
Your Child's Name*

First NameLast Name
MaleFemale
Date of Birth*

DayMonthYear
Age*
Academic Year*
Eg. Year 6
Name of School Child Attends*
Nationality*
Eg. British
Child's Main Home Address*

Address Line 1

Address Line 2

CityState / Province

Postal / Zip Code
Please share any current or previous schools, educational centres, tutors, home-education groups or online programmes your child has attended*
Include home education groups, online provision and part-time settings
Parent/Carer 1 Information

This will be the main parent/carer contact for fees, attendance, permissions (including outings), holiday date announcements and other important communications.
Full Name 1*
Relationship to the Student*
E.g Father, uncle, grandfather, foster carer
Mobile Number 1*
Email 1*
example@example.com
Parent/Carer 2 Information
YesNo
Full Name 2*
Relationship to the Student*
E.g Mother, aunt, grandmother, foster carer
Mobile Number 2*
Email 2*
example@example.com
YesNo
Name(s) of current Tech Bloq students*
Emergency Contact Details

This is the person we should contact if the main parent/carer cannot be reached
Name of Emergency Contact*
Relationship to the Student*
Emergency Contact Mobile Number*
I have read and understood this. (Required to proceed)
Medical & Wellbeing Information

To help us keep your child safe, comfortable and well supported during sessions, workshops and outings, please share any relevant medical or wellbeing information below. We understand that every child is different and not all needs come with formal diagnoses, but anything you feel is helpful for us to know is welcome
YesNo
Please list any medical conditions, diagnoses or health considerations we should be aware of*
e.g. asthma, allergies, diabetes, epilepsy, anxiety, physical conditions, etc.
YesNo
Please provide further information and any required response (e.g. EpiPen, antihistamine)*
Additional Needs, Learning Differences or SEND Awareness

Every child learns differently. Please share any additional needs, learning differences, behavioural traits or sensory sensitivities that may help us support your child well.

This may include:
- Diagnosed needs (e.g. autism, ADHD, dyslexia, anxiety)
- Needs currently being explored or informally suspected
- Any concerns about learning, attention, communication, emotional regulation or social interaction
- Anything you’ve noticed that helps or challenges your child in learning environments
A formal diagnosis is absolutely not required; this information simply helps us provide appropriate support.
Details of any additional needs or SEND considerations (formal or informal). If none, please write 'None':*
Enrolment Acknowledgment
By submitting this form, you are entering the first stage of our enrolment process and giving us permission to begin allocating your child to agreed session(s), while we prepare the relevant payment agreement and enrolment documentation. The enrolment fee becomes non-refundable once your application has been processed.

If a place is not ultimately taken up, we will normally retain registration details for up to 6 months for administrative purposes before securely deleting them in line with data protection requirements. Should you wish to reapply after this time, a new enrolment fee may be required.
I confirm I have read and understood the above information and wish to proceed with enrolment.
Signature

Clear

Enrolment Adminstration Fee

£25.00

Payment Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

Tech Bloq Enrolment Form

Student Information

Parent/Carer 1 Information

Parent/Carer 2 Information

Emergency Contact Details

Medical & Wellbeing Information

Enrolment Acknowledgment