Enrolment Form - BuzzCoding

First Name (Responsible adult if completing for a pupil should provide their details, at the declaration of status below) *

Last Name *

Username *

Please Select to indicate your role *

Declaration of status - By completing this form please, indicate below that you are 16 years of age or above. *

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Email *

Secondary Email (pupil), if different from one above *

Pupil's Full Name and Address *

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Date of Birth * Please enter your Date of Birth

Phone Number *

Pupil's School Name *

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Any health issue to declare? Please list any medical condition you (pupil) have at the comment box below. *

Any Allergy or 'Special Dietary' requirement? Please list them below. *

Comment and Additional Information

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Any previous knowledge of digital coding *

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Indication which group the pupil best fit. (Based on age group) *Cohorts

Please indicate what London Borough the pupil resides in? *

Select Nominal Registration Fee Type (Non refundable) *

How did you hear about us? *

User Password *

Please review the Privacy Policy via the link below, then tick the box. *