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ONLINE STUDENT RECORDS

Please check and confirm that our records are accurate and up to date

TO BE COMPLETED BY ONLINE ONLY STUDENTS

If you would like to also attend sessions at school (including evenings and weekends)
click to be redirected to the IN SCHOOL FORM.

Your Details

First Name

Last Name

Email

Mobile

Student 1

PERSONAL INFORMATION
It is critical that we have current details for . If any personal details have changed you are required by the Ministry of Education to let us know as soon as possible.
MEDICAL RECORDS
Please disclose all medical information that may impact on 's learning or behavior.
ED PSYCH REPORTS
If you have an Ed Psych Report please email this to Pip Block at office@a1student.com

First Name

Last Name

Date of Birth

Previous School

Describe the Student's learning challenges?

Medical records & Medicines

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