Homework Club and Youth Tutoring Referral Form Homework Club and Youth Tutoring Referral Form "*" indicates required fields Student DetailsWhich group is the referral for? Homework Club Zoom Youth Tutoring Full Name* Date of Birth* DD slash MM slash YYYY Gender* Male Female Other Country of Origin* Address* City Post Code School Attending* Academic Year* Class Parent's / Carer's Full Name* Relationship to student* Parent's / Carer's Phone Number*Parent's / Carer's Email Address What does the student need help with?* English Mathematics Does the student have any medical conditions or allergies?* Yes No If yes, please provide details: Does the student need any extra help (e.g. translation, help with mobility, etc)?* Yes No If yes, please provide details: If there is anything else you think we should know, please provide details: Consent* I agree to the privacy policy and consent policy. This includes Leeds Refugee Forum storing your data in order to contact you and keep you updated with our activities. You can withdraw your consent at any time.Agreement* I declare the information given above is correct and that I agree to the rules and regulations.CAPTCHACommentsThis field is for validation purposes and should be left unchanged.
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