ESOL Registration Form – Leeds Refugee Forum

English for Speakers of Other Languages (ESOL) Registration

"*" indicates required fields

Full Name:*

Gender

Date of Birth*

Country of Origin

First Language*

Phone Number*

Email Address*

Address*

City Post Code

Emergency Contact Name

Emergency Contact Phone Number

How is this person related to you? (such as brother, friend…)

English Language Level*

Do Not Speak English

Beginner

Pre-Intermediate

Intermediate

Information for students, parents and carers

Leeds Refugee Forum aims to provide a safe and enjoyable experience for members and children. By signing you agree to abide by the rules set by the Leeds Refugee Forums. To help us do this, please note the following important information. • All questions on the consent form must be completed and signed before taking part in class. * You must notify us of any changes to the information given on the form. * Parents are responsible for their accompanying children and their other siblings.(Please check if children are allowed in your class) * We advise parents to leave their child in their pushchair away from other students and not block the access to the Fire Exit. * Due to Health and Safety Regulations, unaccompanied children are not allowed to play or access restricted areas * Please maintain the Centre’s cleanliness and store the toys and books safely after use at the allocated and designated space.

Agreement*

I declare the information given above is correct and that I agree to the rules and regulations.

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Name

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