AMG Regular Tuition Request

AMG Regular Tuition Request

Please fill out all the fields marked with an *
Student's Full Name *

First Name Last Name
Birth Date *

Day Month Year
Gender *
School
Form
PARENT / GUARDIAN
Name

First Name Last Name
Title
Home Address *

Country
Office Address

Country
I would prefer regular correspondence to be sent to

Home Office
Invoice to (if not the parent, please specify):

Parent
Email *
example@example.com
Phone Number *
Mobile Phone *
Student's Mobile Phone

Tuition Requirements

	Subjects	Levels	No. of hours per week
1
2
3
4

Days and Times available for lessons (Monday to Friday):

	10-11am	11am-12pm	12-1pm	1-2pm	2-3pm	3-4pm	4-5pm	5-6pm	6-7pm	7-8pm
Mon
Tues
Wed
Thurs
Fri

Saturday

	9-10am	10-11am	11am-12pm	12-1pm	1-2pm	2-3pm	3-4pm	4-5pm	5-6pm
Sat

Name(s) and Date(s) of examinations the student is preparing for:

	Examination	Date
1
2
3
4

I understand and accept the charges and cancellation policy. *

Yes
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