Chase Reading Academy Enrolment

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Chase Reading Academy Enrolment Form

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PRIMARY CONTACT (Parent/Caregiver)

Name(Required)

First Name Last Name

Email(Required)

Enter Email Confirm Email

Phone

Billing Address(Required)

Street Address City Province Postal code Country

STUDENT INFORMATION

Student Name(Required)

Student First Name Student Last Name

School(Required)

If not listed, select "NOT LISTED" option, and enter school name below.

School Name (if not listed above)

Grade(Required)

Home Language(Required)

English

Other

Other: Please specify

Gender

Male

Female

Rather not say

Special Education Needs (SEN)

Optional. For internal use only. Will not be disclosed to student.

Yes

Please specify below:

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Subscription & Pricing

Please indicate your preferred subscription option below. Once your enrolment is complete, you'll be directed to select the subscription product, and proceed to checkout to finalise payment.

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Subscription Selection:(Required)

Monthly Subscription - R150 per month

Annual Subscription - R1495 per year

Designated Learner Support Contact 1

Tutor, Au Pair information etc. You have the option to add two learner support contacts that will have the same Amira access as the primary contact.

Relationship/Role

Name

First Last

Designated Learner Support Contact 2

Relationship/Role

Name

First Last