Booking Form – The Carlow Academy

A Booking Form (One Form Per Student Must Be Filled Out)

Booking Form

Disclaimer: Filling out this Form is required for all grind/study packages, workshops & courses
Student's Full Name*

Please provide first name and surname
Student's Date Of Birth*

Day
Month
Year
Student's Email Address (please include a GMAIL email address here if this booking is for grinds or a workshop)*
Student's Contact Number*
Name of School as of the academic year 2024/2025*
Year Group (in school) as of the academic year of 2024/2025*
Parent/Guardian Name*

Please provide first name and surname
Parent/Guardian Email Address*
Parent/Guardian Mobile Contact Number*
Home Contact Number OR Second Mobile Number (in case of emergency)*
Chosen Service OR Package OR Subject for Grinds Sessions*
Please select ‘Not Applicable’ if necessary. PLEASE MAKE SURE YOU SELECT THE CORRECT OPTION FROM THE PRE-LISTED DROP DOWN MENU ABOVE.
What EXACT Package(s) OR Course(s) have you booked your son/daughter in for?*

If you have purchased more than one service then please list ALL items purchased ‘Additional Information’ box below as per the titles in your post payment checkout email (packages, courses, notes etc.). This is just to make sure we are clear on the exact booking details for your son/daughter so that they are placed on the correct lists.
Please let us know where you heard about us e.g. from a current or past member, on social media, radio etc. Please give as much specific details as possible.*
^Please expand as much as possible
Please fill in this box if you are booking into our STUDY CENTRE and there are set day(s) that you WILL NOT be attending study and also if you have a list of set days and times that you will arrive late and/or leave early on a weekly basis during our opening hours listed below the box
We can then upload this information to our online attendance system so you will not have to text us daily/weekly to confirm any days and times listed. Our study centre times are as follows: Mondays to Thursdays: 4.15pm to 6.15pm and 6.30pm to 8.30pm [includes a 15 minute break] Fridays: 2pm to 4pm and 4.15pm to 6.15pm [includes a 15 minute break] Saturdays: 10am to 12pm and 12.15pm to 2.15pm [includes a 15 minute break]
Doctor's Name

Please provide Doctor’s first name and surname
Doctor's Contact Number
Medical Information (if applicable)
Please provide us with all necessary details for your son or daughter’s medical condition(s) and also what needs to be done/happen in a case of emergency.
Additional Educational Needs (if applicable)
Please provide us with all the necessary details of any Additional Educational Needs that we need to be made aware of so that your son or daughter’s can make real progress at The Carlow Academy-this information will only be disclosed to staff who will be dealing with your son or daughter.
Any additional information (if applicable)
Do you wish to notify me of absenteeism?*
- Yes
- No
Sign up to the 'newsletter' to keep up-to-date with all services and special offers supplied by 'The Carlow Academy'*
- Yes
- No
If a student must leave early, the parent/guardian should inform us via text of this at least 24 hours in advance if possible. If late or returning from an appointment then they we should also be informed. This is all in the interest of safety for your child so please give us as much notice as possible. Please read our Admission Rules for further details.
Privacy Policy Consent*
I agree to the privacy policy.
Admission Rules Consent*
I accept the Terms & Conditions.

A Booking Form (One Form Per Student Must Be Filled Out)

Disclaimer: Filling out this Form is required for all grind/study packages, workshops & courses

Want To Have A Consistent Routine? Then Become A Member Today

Want To Have A Consistent Routine?

Then Become A Member Today