Butterfly Classes Application Form

Butterfly Teaching Resources Butterfly Classes Registration

Please complete the form below to apply for your child to have a reading test, to join, or to continue at, our Saturday Butterfly Reading Classes.

Butterfly Classes Application Form

Name of child

Date of birth of child

Is child male or female?

Male

Female

What school does your child attend during the week?

Is your child entitled to Free School Meals (or FSM)?

Yes

Prefer not to say

Does your child have Special Educational Needs (SEN)?

Yes

Prefer not to say

If your child has Special Needs (or SEN) you can tell us more here. (optional)

Are you the parent, friend, relative or the legal guardian?

I am the mother

I am the father

I am the legal guardian

I am a relative of the parent

I am a friend of the parent

Country or Family Origin

Does your family speak English as an Additional Language (EAL)?

Yes

Name of another person we can contact in case of emergency

What is the relationship of the other contact person?

Mother

Father

Guardian

Family friend

Other

Phone number of the other contact person?

Email of the other contact person (optional)

The date you completed this application form

Have you completed a Butterfly School application for your child before?

Yes

If you have completed a Butterfly School application for your child before, can you tell us in which month and year? (optional)

Is your child already attending Butterfly School Classes? (optional)

None

Yes

If your child already attends Butterfly, or you would like us to give your child another reading test, which class are they in now? (optional)

Anything else you think we should know (optional)

Declaration

I confirm that the above information given by me is correct and can be used by Real Action in accordance with their Privacy Policy.

Online Privacy policy

Communication preferences

If you are a human, ignore this field

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Real Action, The Learning Store, 3 Mozart Street, Queens Park, London W10 4LA Registered charity number: 1072633 ✉ [email protected], ☎ 020 89603282