Learner Registration Form

Parent / Guardian / Sponsor First Name *

Parent / Guardian / Sponsor Last Name *

Parent ID

Home Address

Phone Number

Email

Student Full Name

ID Number

Date Of Birth

Gender Gender Male Female

Last School Attended

Last Grade Passed

Current Grade

Proposed Grade

Grade 10 - 12 Subject Choices (Select 4 compulsory subjects)

Grade 10 - 12 Subject Choices (Select 3 elective subjects)

Other Subjects

Students Valid ID Copy

Students Last Report Card

Signature *

Please Invoice Me

Payment Terms

Payment Method

WEC Representative / Agent Name