Email tanderson@cleverised.com
Phone 702-468-7726

Giving your child the best start in life

First Floor, 10A Chandos Street London New Town W1G 9LE

Registration Form

Employee Referral

⁠Child’s Basic Information

Full Name *

Date of Birth

Gender

Home Address

Home Address

Home Address

Home Address

City

City

State/Province

State/Province

Zip/Postal

Zip/Postal

Primary Language Spoken

Health Snapshot

Allergies?

If Yes

Write only if you chose ‘Yes’ above

Currently on Medication?

Diagnosis? (if any):

⁠Parent/Guardian Info

Full Name *

Phone Number *

Email *

Immunizations Up-to-Date?

Diagnosis Report Available?

Quick Checks

How will tuition be paid? How will tuition be paid?

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